Homestead_RossLUI111 1 _'JK HU'L ,) IIJIU I'10'MI I Itv u`Uil Iuh IUV\ -L)-CIG
S[E BACK FOR FILING IISTRUCTIONS
certify that on the 1st day c !
yo_rch, 19cl.0, I, (`r1e) VccuDied bs our principal place of residence the .follvaing described real
nroperty . for which a laips�ead Property Tax Credit is hereby -being claij6al:
1 YT M.
.El aTe.buyinq u:rler contract
❑ have a heneficial interest in the taxpayer
Pro_ -°rty. Description in County
TaL�:ing District (City, Toom,. 7bwnship)
bo tp3q
' I
i � 'lb,airhi i
i
Pe1cel Fiu-rler or legal description slrnm on tax statomst:
!- bu':1i77 on c:Dntract: 0+,n° —rs name (Tee sijmle avmer
Contract recorded in P200rder's Office - P_ecord Ia. Page
If any oortion of the residential structure or the land, not e:r etali.ng one (1) acre that
iii Cllat°_ly sLT- rou -i0s `hat structur -e is used to produce lllccine, describe the use alll uor Lion or
t! ?e oro- -_ tv u`i.' Zed to prcduce in::one
any other counties in which indi%-�dual c.,,ns or is buying real pro p°.rty: QountV itr:.nsiuo
-)y certify i-ne 91Fve state cent is true, NrreC't airl caip °te. -( I (� W
::acure
s` e t Pl'iiress City St�atei aid Zip Wu.;
* - ndividual eitlnr a•.'ns or is b.:ying uner a contract that provides he a .
_dro _ rt y taxs on the residence, or has a beneficial interest in tIi_
- FOR ASSESSOR `S USE ONLY - NOV 2 7 1989
Iraf ;:.i e:'cee.,'ng 1 (one) acre iRiue lately
surrour ing. residcnial iRQrOV'Eiil'llts
Tobfal Land
Residential IroroVelrents
I7.aellinq
Garage
Zbtal
(1) •
(Z) .
(3)
(4)
(5)
(6)
Ot ^.°r %M:Drovenents (7)
lib - T, ne (6) plus (7) .equals (8) (4)
True Cash sed Ikairste:.:
Value - %tBDii�
� Ty he a}.XXoI.? is true, correct
aril CC7imlet°_.
1 ^ -ilat re OL 'assessor
- ACTiON BY AUDITOR -
to
p • �� Date: