HomeMy WebLinkAboutHomestead_Douglas (2)!-0RM HC 10 1979
RescriDM By State Bwrd ol Ta. tammissioners
To & FiIW in DupliWle
CLAIM FOR HOMESTEAD PAOPEATY TAX CREDIT FOR YEAR 19�� `
SEE BACK FOR FILING INSTRUCTIONS �r+'��
�arch, 19�, ,N(We) occupied as our principal place of �
h' h H d P T C d' ' h b b'
��LY
certify that on the 1st day of
the following described real property for
w ic a omestea roperty ax re it is ere y
/
❑ are buying under contract
❑ have a beneficial inte est 'n the taxpayer
Property Description ir�, County Township
Taxing District (�ii�y-�ewa; Township): \�G}-TY„c�..n
Parcel Number
If buying on contract: Owners
or 1�5a1 descriofion shown on tax statement:
�f�'� � � ' /� �. 6 D Qu��
Contract recorded in Recorders Office - Record
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:
� hereby certify_the above statement is true, correct and complete.
'�
County Township
Ciry. State ana Zip Cme
` 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 immediatety
surrounding residential improvements
Other Land
Total Land � �
Residentia�pr�veme� Dwelling
�l
Garage
. iU�I 51979. .
- Total
Other Improv ents
�T ' ' Impr� r equals (8)
�y certify he aboy� �hi�L�rrect. and complete.
n _ .. X� ,
True Cash
Value
(1) Soo
(2� '�So
(3) 9Sv
(4) Siso
�5, -
(s) s�so
(7� 3G � o
(g� 87L o
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
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G- 5-79
Daie
Date: �' S