Homestead_SkinnerCLAIM FOR HU'LE-SUD PRUPERH TN; CRUIT FOR ON 19 6� p �/
SEE BACK FOR FILING INSTRUCTIONS O'D
certify that on the 1st dal
i• +arch, 19 , I, (We) occupredduur principal place or residence the foll.o.;ing dscrit�d re�-1
oFerty for -which a Horr�t-ad Property Tax Credit is hereby being claimed:
CNe) Ej-o:med
are buying urcier contract
have a beneficial interest in the ta} :payer
p ccerty Lescription. in County To.,rsi
T'a>:ing District (City, Ta,n, To',,=llip)
Parcel nulc�� TT� or legal descrip i s}�own on tax state+�t:
if buvina on contract: Q:rners noire (fee sirruDle a•mer
Contract rworded in Pecord=r's Office - Record t•b. Page
1` a;iy por=tion of the residential structure or the land, not e.,=eeding one (1) acre that
irnediately surrourds that structure is used to produce inane, describe the use and corticn
the property utilized to produce irro+re
Pny other counties in which individual owns or is buying real property: Count,/ T
Tc:msiuo
T hereby certify the above statorent i
is true, correct and complete.
Sta v
'Lip U,
Street Fr3ctress C
City, S
x3 '
( 'Sigi t S
toying uner a contract that provides h
he is to pay the
property taxes on the residence, o
or has a beneficial interest i
in the tax-payer.
- FOR ASSESSORS USE ONLY -
True Cash A
Assessed I
IICnI^st_
value V
Valuation V
Valuati
Lard not exceeding 1 (one) acre inuedi.ately (
(1) / 0 00 3
3 (10
surrounding residential irr, rovenents
2 /
Other Land 2
/ /� /�
(3) r
r/ r,/i /�
Total Land /
//� / ,
Pn '
Dwelling (4) /
Ar /
'q.tdential 1
Garage (S) A
/
Total (6)
MAY 5 1086
(7)
otlier Iuprovenents