Homestead_Chamberlain (3)pitsclIM By $Iale $oara of tax COFIMUSSIon"s
CLAIM FOR H016ESTEAD PROPERTY TAX CREDIT FOR YEAR .19 `t—
SEE
r {BACK FOR FILING INSTRUCTIONS �� �.
I (We) — �. 4- `'f , I (\ ' �.v 6J n.+�tp_l1 e i(y that on thS
ch, 19_ I, (we) cupied as our principal place of residence the following described real
h a Homestead Property Tax Credit is hereby being claimed: ���e18 '7y'?a3$ c'. 41S
I, (We) owned �'
❑ are buying under contract
Z. R=
❑ have a beneficial inte e t in the taxpayer ` ° a
Property Description in County ( M, r) /k k4olof 0 !t- Township
Taxing District (City, Town, .Township):
Parcel Number
If buying on contract Owners name Ilse simple O..eq
or legal description shown on tax statement:
?� NI w' /L[ -09
Contract recorded in Recorders 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: County Township
I®hereby certify the above statem i true, correct and complete.
1 ' �� l✓ v.. P mil S
'Signalmc Street Aamess .. City. Slale ana Zip Cloac
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 -
1RUM
SEP 1 1 1980
Lang t`' t 6i MK acre immediately
surrounds �T 0 Improvements
Other Land
Total Land
Residential Improvements
True Cash
Value
(1)
(2)
(3)
Dwelling (4)
Garage (5)
Total (6)
Oth- Improvements
To'sPnlprovements - Line (6) plus (7) equals (8)
1 hereby certify the above is true. correct, and complete.
S,90IDW[ pl Assem,
ACTION '
(7)
Assessed Homestead
Valuation Valuation
Come
049
WHEN