HomeMy WebLinkAboutHomestead_Harper (2)FOB; HC 10 1979 To Be Filed in Duphoate T
Premribed By Stale Board of Tax Cammissioners
CLAIM FOR HOMESTEAD PROPERLY TAX CREDIT FOR YEAR 191
�I/' SEE BACK FOR FILING INSTRUCTIONS
�(We) S1_A S+— 46—Al certify that on the 1st day of
aarch, 19'�F-, I (We) occupie as our principal place of redibence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Cl owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �CLc�CJ—Q—e-+✓ A County Township
Taxing District (City, Town, Township): v a
Parcel Number
If buying on contract: Owners name
or legal description'shown on tax statement:
Q _t, a- %2 h(j)V1 /Y of -? :?,o 9da.L..0,
Contract recorded in Recorders Office - Record No. Page
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:
®hereby certify the above statement is true, correct and complete.
r ld
County Township
Slat/arid zip Woe
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 (o ediately
surrounding residential imve ter s
Other Land ED
Total Land JUN 2.7 1979
Residential Improvements Dwelling
arIge
AUDITOR Total
Other Improvements
Tv,-' Improvements - Line (6) plus (7) equals (8)
I oby certify the a"ve is true, cgfrect. and complete.
Signature of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
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Dane
Date:,_ A