HomeMy WebLinkAboutHomestead_PenrodPtewibed By Stale Hoald of tax Commrssioneis
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CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FUR YEAR 19�� /
SEE BACK FOR FILING INSTRUCTIONS /
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, ' �1 _ _
certify that on the 1st day of
1. Mo 19 I, (We) occupied as our principal place of residence the following described real property for
which a Homestea Property Tax Credit is hereby being claimed:
I, (We owned
❑ are buying unifier contract
❑ have a beneficial interest �in�the� taxpayer
Property Description in ` T County Township
Taxing District (City, Town, Township):
Parcel Number-
If buying on contract: Owners name °Ce simp1C
or legal description shown on tax statement:
Q7
Contract recorded in Recorders Office - Record No
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 -1 ownship
11-'-^by certify the above s ement is true, correct and complete.
Ir n '�\ n
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.
CE D - FOR -ASSESSOR'S USE ONLY -
JUN 1 1989
-and not edng(o�Elr2cr8Simmediately
surrounding residgglla1lTl6-fflr &ements
hher Land
total Land
3esidential Improvements
True Cash Assessed Homestead
Value Valuation Valuation
(1)
(2)
(3) —
Dwelling (4) —
Garage (5) - --
Total (6)
Otherrovements (y) _ --
iota. Line (6) plus (7) equals (8) (8)
I hereby certify the above is true. correct. and complete.
Signawle of Assessor
ACTION BY AUDI FOR -
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