HomeMy WebLinkAboutHomestead_FreemanPrescribed By Slate Boma of la. Commlwoll ,s
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEA
R
EE BACK FOR FILING INSTRUCT -IONS
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1, �) __ certify thal on the 1st day of
Tula. 19 I, (We) occupied as our principal place of residence the following described real property for
which aHomestead Property Tax Credit is hereby being claimed: Q
I, (WeYl Ho owned �Co - ��`��- �� - O� ep7o�-
❑ are buying under contract
❑ have a beneficial mte est in the taxpayer
Property Description in 2 County Kam{ Township
Taxing District (City, Town, Township):
Parcel Number'
If buying on contract: Owners name Vee simple d ""e`i
or legal description shown on tax statement: -7-)7-. /c6,Q
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Contract recorded in Recorders Office - Record
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 Township
I h-- -by certify the above statement is true, correct and complete.
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Address Or,. Siaie a, /1 zn, code
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 -
-and not exceedtflgdt(ope acfe�i mediately
wrounding residential improvements
)then Land MAY 2-) 19.89
Total Land JIZ�
3esidential Impr� novel a sOR S Dwelling
Garage
Total
Other rovements
Total srovements - Line (6) plus (7) equals (8)
1 hereby certify the above is true, correct, and complete.
True Cash
Value
(1) $ O o
(2) x 0 7 0 0
(3) a3S-00
(4) (z, 9op
(5)�S�o
(6)
(8) 7400 =
Signature dl Assessd,
- ACTION BY AUDITOR -
D. ,c.c.s
Assessed
Valuation
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-7 8 3 a
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tairo
37 30
Homestead
Valuation
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