Homestead_Brown (3)rc v.za D" =.. 00 11 N las
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1999 °Qs' 0/`183-00
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SEE BACK FOR FILING INSTRUCTIONS
I. 11A/e) t)uA � I) vv,,, • `� Rain c� CEO_, 1 ...J certify that on the 1st day of
A• :, 19 I, (We) occupied as our principal place of residence the following described real property for
wh a Homestead Property Tax Credit is hereby being claimed:
I, (We) $owned OpS- o�`�g3
❑ are buying under contract
Q hove q honnllrinl Inin14n1 It ^ Mrs Mrs Irl � US ��
Property Description in ' County Township
Taxing District (City, Town, Township):_ `m(j,
Parcel Number . or legal description shown on tax statement:
?? ,(. W''a SE,''y 17 -a -1( )g -)YIK-
It buying on contract: Owners name (led Bimp1e
Contract recorded in Recorders Office - Record No. •5 Page
If any portion of the residential structure or the land, not exceeding one (i) 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
rpby certify the above statement
is true,
correct and complete
f- a,,.,
e,
3 11-e
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Street Address
coy. State and Zip
7a
Individual either owns or is buying under a contract that provides he is to pa��e . perty; tax
on the residence, or has a beneficial interest in the taxpay�e19 I
FOR ASSESSOR'S USE ONLY -
True Cash
Value
and not exceeding 1 (one) acre immediately
urrounding residential improvements (1)
ther Land (2)
otal Land (3)
esidential Improvements Dwelling (4)
Garage (S)
Total (6)
ther Improvements (7)
otal ovements - Line (6) plus (7) equals (8) (8)
hers; ertify the above is true. correct. and complete.
1114 =;ir o 1 19189
s d� � t, jp�pes'ion
a r' IT OR aluation
gnature of Assessor p,n,.
rI ,,,�, - ACTION BY AUDITOR -
,pproved:_ �" "" �` �' •� Date: _._ ��' -9�___