Homestead_LytleTo Be Filed in Duplicate
Board of Ta. Commissioners '
yS\a� CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
F°Pa`c `a
residence the following described real property for
which a Homestead P.ropertj Tax Credit is hereby being claimed:
I, (We) 01owned '
❑ are buying under. .con"ct" '
❑have'a'beneficial interest.ih.flie taxpayer
Property Description in /° � ' —Countyq �p Township ..
Taxing District (City, Town, Township): L
Parcel Number or legal' description shown' " on iaz `statement:
oRr
If buying on contract: Owners name
.77ea ymoe ow:):
Contracf" r4orded ",in. Recorders Office - Record No. Page If any portion of the residentiaf`sIiucture or tfie 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 individuaT'ownsor is tiuying real property:
by certify the above staternent:is_ true; correct and complete.
County Township
46d
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 -
True Cash Assessed
Value Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) A4 Z-0
Other Land (2) '
Total Land ``�� (3)
Residential Improvements FIX11 .9_, a)
Ga, (5)
1�1Aotal�e I�81 (6)
0�`�r ovments �
al oveements - Line (6) plus (7) eq�ualso(8)AUDITOR (6)
1 hereby certify the above is true. correct. and complete.
Signature of Assessor
Homestead
Valuation
- ACTION BY AUDITOR -
Dare
r •t---
Date: —
Fill'.