HomeMy WebLinkAboutHomestead_Hamm (3)l,Uill'I FU% IIUL0ILI-U FINI C7 \1I rr -v\ krv-utI rvii iuv%
SEE RAC, FOR FILING INSTRUCTIONS
;`) certify that on the 1st day J I
P rcll, 19�, I, (We) occit Died as our -principal ola e of residence the .folla4ing described real I
r� cv y a t olrt?stea3 Prop°sty Tax Credit is hereby being clabnal: o0ya�_ . FSi - - �
Ej are buyinq urrler contract I
have a beneficial interest in the taxpayer
?� *•_rty Description. in County
r
Ta ng District (City, Town, 'I1uvns1tip) : l" �1
?>arcel IItmLbar I I I �or egal descripti sl own on tax statairst:
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I= buying on contract: Owners mare (fee sirrmle comer)
Contract recorded in Recorder's Office - Record Ib. Page
I` a;iy portion of the residential structure or the land, not exceeding one (1) acre that
r Yiiately su ourr3s 1 at structure is used to produce inane, describe the use arrl cortion or
the propsty utilized to produce irrorre
Pnr other counties in which individual cfnms or is buying real pro party:
I ' ®h certify the ab� st�rmnt is true, correct and complete.
County 'IYf:ms)uo
nature Street Icddxess City, state aid zip uo --
*Individual eitJn_r evens or is buying uner a contract that provides he is to pal the I
propaarty taxes on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR IS USE ONLY -
Lrd not exceeding 1 (one) acre i'me-diately
surrounding residential inprove eats
Other Lind
Total Laid
P°sidantial lnprovelmnts IIaellinq
Garage
Total
True Cash
Value
(1)
(2)
(3)
(4)
(5)
(6)
Other Irro ovanens (7) —
'lb I1lmrove(ILlts - Line (G) plus (7).eauals (8) (B)
Araby ceiti -fY the above 1s true, cOr-rect, al-0 ccimlete.
i-nature or ,- sseSSOr
- ACTIOII BY AUDITnR -
Date:
Da to
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}La rte step.::?
Valuation
Valuatic:i
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