Homestead_Deal (6)rre]lnbcd UV S1.nc UUJI0 ul I— w : !:.ulurs
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
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SEE BACK FOR -FILING INSTRUCTIONS
9.a Y �)> r
`O(we) - certify that on the 1st day of
rch, 19__%j_ I, (we) oc pied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
1, (we)%Et wned tvrJS' 0,, 7/a
❑ are buying under contract /
❑ have a beneficial interest Qi� t(�he, -ta,xpayerN.
Property Description in _b!>1t1 County Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax, statement:
If buying on contract: Owners name pee slmole Owneq
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 statement is true, correct and
complete.
Wre Street Address
� � •
, �r��
Individua l either owns or is buying under a contract
that provides he is to pay the proy
on the residence, or has a beneficial interest in the
taxpayer.
JUi\12 B 1939
FOR ASSESSOR'S
USE ONLY -
aW'0'_.UA' n'z .frs
True Cash
AssessedUDITO1" Homestead
Value
Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
(1)
Other Land
(2)
Total Land
(3)
MEN=
Residential Improvements p
(4)
Dwelling
Garage
(5)
Total
(6)
—
Ocher Improvements
(i)
_
Tremprovements - Line (6) plus (7) equals (8)
(8)
I . ,y certify the above is true. correct. and complete.
Srgr Lure OI ASSCSSOr
- ACTION BY AUDITOR
-
n
Approved:
nq
Date:
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