Homestead_Fisher (3)FOFM HC 10 1979 �
Presuibea By S�a;e Baam of Taz Commissionea
ia Be Filed in ou0���ate
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 19 �� �^q
SEE BACK FOR FILING INSTRUCTIONS �QS -a0, °�
��We)�'��-�-✓, /� �" ��• certify that on the 1st day of
arch, 19��, t, (We) occupied as our principal plac of sidence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: �
I, iWe) l�,owned �Cy ��-�l •dQIJ-0111J. .S�oi-Q�/
❑ are buying under contract
❑ have a beneticial interest in the taxpayer _ �
Property Description in�� County � o ��-- Township
Taxing District �6ity, Fewrt; Township): o-�a�-� '�
Parcel Number
If buying on contract: Owners
or legal d�scription shown on tax statemeni:
�> SCC! y /— 3— / � , 7T3'"
Contract recorded in Recorders Office - Record No
If any portion of the residential structure or the fand, 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.
�'�l'I� �P�.� �R, �s D �
Adaress
County
;
Township
am Zio Cooe
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) acce immediately
surrounding residential improvements
Other Land � � �0 �
Total Land ,����� � ;� ��{7�
Residential Improvements Dwelling
� y�, Gara�„�p„tr
'/i' Total
j� AUDITOR
Other Improvements
ments - Line (6) plus (7) equals (8)
fy the above is true. correct, and complete.
ACT
Approved: / \. v � �
—�
True Cash
Value
r, � 3 9 0
�2) ` d �
�s� ,� 9�?
�4� l 93 �
c5> -�3�c�—
ts� / 9.� �- o
(�) J ° —
($) � p.� �-�
Assessed
Valuation
�%�
90
— e --
_ .
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Homestead
Valuation
�- � �
J`�—/ ��7�
Da:e -
Date: _�J G