HomeMy WebLinkAboutHomestead_Eadsr�axch, 19
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IAJA WI FUK, f IU 'L3I LfU 1 "KUI'IJU i I1-V% U LV l I } Ur i u vA 17YO
S- 13A.CK FOR F 1PIG INSTRUCTIONS
4 certify that on the 1st day cI
Vie) occ ,ice as our princioal place of residence the .following described real
a l o frs teal Drop'sty Tax Cxecli t is hereby - being claiircci:
are.buyirq T:rrler con�rac�
hove a bei-,eficial interest in the taxpayer
prop°rty Description ' ill County
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T1 --:-ng District (City, Tow-n,. '?bwnship) : A ?2,,: �
?arcei ilulbar I or legal description s}rrnl on tax statamst:
1= bL'',•li'.'7 oil Contract: Q,?'.ers mTte ( simle amer)
r -e j in Pecorcler's Office - Pe ord lb. sJ'_
I_` aiiv ooi 51L °ntial structure or the land, not e>sealing one y` ae }plat
ii-ii d ately S� nL�p}nat structure 1s Used to produce 1nc_Qfie, describe Ule use ald LOrtion Oi
OroC °�t'Nf+`ll �cC QJm orc:aUce 1rcoire
pi-.y Other
individual a,Ts or is burring real property
1,1iv the above staterent is true, correct an3 coTrplete
'Z 12
county Tor..-nsiuo
'fate rl 'L
na,cu:e Street Adaress al
*7 ndivicical eit}n_r a +°ns or is blying caner a contract that provides he is to pay the
pro ty taxes on the residence, or has a beneficial interest in the taypayer.
- FOR ASSESSORS USE ONLY -
not exc°_ea'l lg 1 (on. e) acre ijlue lately
surrounding residential i. DrovEinnts
Other tan l
Total turd
P --side_ntial InprovErrints 1xielling
Garage
Total
Otl, °r 1"MrOi.ementS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
True Cash hssessed
Value Valuation
`ice l,wurts - ;,ne (G) plus (i).eouals (8) (8)
I ;ner:. c� if-,, t1,e i_ is true, correct, and cuimlete.
,I
Si ^nature o assessor
- ACTIOH BY p501TM -
Date:
to
Valuatic:
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