Homestead_Dearing (2)CLAIM FOR USTEAD PROPERTY TAX CREDIT FOR YEAR ]9 .L--'
/�- SEE BACK FOR FILING INSTRUCTIO-N��j. O
d 0 4-+�_ ham. certify that on the 1st day of
cuDied as principal _ ce of residence the following described real
property for which a Hn=Pastead Property Tax Credit is hereby being claimed:
'
❑ owned oY7(; / d� /D - /G�- (/DD. `�do -Qa/
are buyincrurder contract
have a beneficial interest in the taxpayer
er on_ y�
property Descripti in G�BSo n/ County / / /oni'TgomercL TowrshiF
Taxing District (City, Tm'n, Township):
Parcel ihurner or legal description shown on tax statement:
/�/ ��. /yGcJ �`i nJ u.l ��f /• o � .
Tf buvinp on contract: Owners rOffe (fee simple owner
Contract recorded in Recorder's Office - Record No. Page
If any portion of the residential structure or the land, not e.=eeding one (1) acre that
imneaiately suzr ds that structure is used to produce inane, describe the use and portion of
the property utilized to produce income
Pny &Ll,= counties
in which individual owns or is buying real property:
county
Township
�exeby certify the above statement is true, correct and corrplete.
Street 7dress
City, State
and Zip Code
xSignature
buying a contract that provides he is to pay the
*Individual
either owns or is uner
the residence, or has a beneficial interest in the taxpayer.
poperty tapes
on
- FOR ASSESSORS USE ONLY -
True cash-
Assessed
Hamstead
Value
Valuation
Valuation
Land not exceeding
1 (one) acre irr ediately
D
/70
su rrounding residential
1 ioverents
r=r
other Land
_
(
(3)
Total land
Pesidential Irmrvverents
Dwelling
(4)
Garage (5)
Total (6) 31070 10340
i
C`l.er Inmrovenents (7)
To 7no.,crWnts - Line (6) plus (7) equals (8) (8)
I- hereby certify the above is true, correct, and curmlete.
40�' Date
S1Qnature of Assessor .
- ACTION BY AUDITOR -
Date:
P=roved: