Homestead_Garrett (3)FOFM HC 10 /979 To Be Filea in Duplicate
Prescri6e4 By S;al^ Bwrd oi Taz Cammissione�s
CLAIM FOR NOMESTEAU PROPERTY TAX CREDIT fOR YEAR 19 � 3
SEE BACK FOR FILING INSTRUCTIONS `�'CA�`Q �
�\vVe) !°`-°-'-""""� • v��-P-���' ��'�'�`�'`" 7`' certify that on the 1st day ot
March, 19 S?.3 I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) �wned �L.�"/-�J`�- � -Q�JO. �(O�-dol�
❑ are buying under contract
❑ have a beneficial interest �i(n�,/ th�e taxpayer
Property Description in /J-��.-a-^- Cou
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl coniract: Owners name ��� simple owneq
_ ' " `"" "` c�s-'"^"'4'� Township
�vr, . -,e- _ .
or legal description shown on tax statement:
�� . �c %y- `f- 3- i Z . �c� a�.
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
s[ructure 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
��hereby certify the above statement is true, correct and complete.
Y
'Signature Sbeet nEtlress Gry. Sta�e an0 ZiD �e
� °'dQa�-u g `�i�+�`c2+! �vw(Dw7
' 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 improvements
Other Land `�
Total Land i°,�i ���
Residential Improvements
, r:�a•r � 1983
� � O AUDITOft
Dwelling
Garage
Total
True Cash Assessed Homestead
Value Valuation Valuation
(�l � � /�D %�
(2) —
(3) /�
�a� a i
cs)
(g) � 8 0
Other Improvements (�1
1'�Improvements - Line (6) plus (7) equals (8) (8)
I by certify the above is true. correct. and complete.
�3..�� � . /���
Signawre of Assessor
Approved
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- ACTION BY AUDITOR -
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Date: