HomeMy WebLinkAboutHomestead_BaughnCLAIM FOR HUIE51FAD PROPERTY TAX CREDIT FOR YEAR 19 dpi
SEE BACK FOR FILL INSTRUCTIONS -000
I,`•=�e) vl Lt/, {�, certify that.on the 1st day of
*'- - ^h, 19 I, (&) oc as our principal place of Yysidence the following described real
�jerty for which a Hrmma ead Property Tax Credit is herebyy/ being
J/c� claimed:
I, Me) E�'owngi
Lj are buying under contract
❑ have a beneficial interes
Property Description in _ 4e.4
Taxing District (City, Town, hi'
Parcel ihzrber
in the taxpayer
,.a.rr► County �. Township
or 1 description shown on tax statement:
. sc //'j 1-3-1.2 tot
if buvina on contract: Owners name (fee simple owner)
Contract recorded in Recorder's Office - Record No. Page
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:
? ereby certify the above statement is true, correct and complete.
County Township
ty,
*Individual either owns or is buying uner a contract that provides he is to pay the
property taxes on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSORS USE ONLY -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements Dwellinq
Garage
Total
True cash
Value
(1) Oii
(2)
(3) .rep
(4) O O
(5)
(6) A O 71 o
Assessed
Valuation
/70
to O D
Other Improvements (7) _ —
To Imuprovements =Line (6) plus (7) duals (8) (8) '20710 OO
I hereby certify the above is true, correct, and complete.
Date
0-gnature of Assessor
- ACTION BY A.UDITnR -
Approved
Date:
homestead
Valuation