Homestead_Denning (5)warn xc �o �ers
Reurinea By State BoarE of taa Commiuioners
To & FIeO in Duplicate
CLAIM �� HOMESTEAD PROPERTY TAX CREUIT FOR YEAH 19Z� .
���� SEE BACK FOR FILING INSTRUCTIONS po5'��af
��We) ^Do y�_ � �i����p� certify that on the 1st day of
rch, 19 I, (We) �pied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
�, (We) � owned �(O �6 :�/ ���� —4� /�� Q� _
❑ are buying under contract
❑ have a beneficial in rest in the taxpayer
Property Description in—'�S=c�s�l�'J C�ounty Township
Taxing District F.Gi�y,_3�ua,.Township): �� P��9ti6qs.�/
Parcel Number
If buying on contract: Owners name �'� "'"°'a
legal' descYiption shown on tax statement:
s �. '� /1/l.�e � � 7- .� -�/ 3, , 3 � ,._
Contract recorded in Recorders Office - Record No
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:
tiereby certify the above statement is true, correct and complete.
�i/� , �� � Pl��'� ,2.._. ��,.__
County Township
' 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 -
Land not exceeding 1(one) acre immediately
surrounding residential i�rovement� � �
Other Land ��
Total Land
Residential Improvements .;�5�+2� ����
Dwelling
�% a�
(/l , � /��a./i�?=%�al
Other Impravements � AUDITOR
rovements - Line (6) plus (7) equals (8)
certity the above is true. correci. and complete.
ol Assessor
Approved
True Cash
Value
( t ) S-e--o
(2) �% o-0
(3) 7 O O
�a> /33 Yo
�5� - o —
cs� / 3 3 s1 a
(�) _'°�
�a> I 3 3 b' o
����I:i�l�������i�.
Assessed Homestead
Valuation Valuation
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S -9-79
Da:e
Date: � � C