HomeMy WebLinkAboutHomestead_CloinFORA HC 10 1479 To Be Filed in Duplicate
Prescribed By Stale Board at Tax Commissioners
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 192
4�
SEE BACK FOR FILING INSTRUCTIONS �� - 00/
"R(We) -j 21- certify that on the 1st day of
arch, 19 I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: -
I, (We) owned
are buying under contract
❑ have a beneficial int rest in the taxpayer
Property Description in Countyn C��dI•C. -c
Taxing District (City, Town, Township): a -!? f✓a� —�
Parcel Number or legal description
.'7 n /Z
If buying on contract: Owners name (fee simple owner) J'&Ujfh, SF
Contract recorded in Recorders Office - Record No.
Township
on tax statement:
1P - -2 -8 .396
2
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property: County
hereby certify
the
above statement is true,
correct and complete
V' /V �hMAiMn
/ /r1n. / T {/i ( _
/
l /ll iiA,/ " /L1 /Z
'.�7n
Township
and Zip Code
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1 on cre i med ly
surrounding residential�proemelRs
Other Land �j !�
Total Land
R d t al Inn o ements
trgv ,2&1979
esl en fl ,f v nwellin
Other Improvements
Signature of Assessor
9
all age
AUDITOt�
/T otal
(/
plus (7) equals (8)
rue. correct.(and complete.
True Cash
Value
(1) _/030
(2) —49—
(3) /0.30
i.1
Assessed
Valuatinn
Homestead
Valuation *�j0
Approved: Date: -5- 3 d % �/