Homestead_GentryFOflM HC 10 19i9
P�escri6ea By S�a;e BoarO ol ta. Commisslon_rs
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 9
SEE BACK FOR FILING INSTRUCTIONS
io Be FiIM in DuDlicate
EjpS- i7��-t�,
�We) `f - certify that on the 1st day of
rch, 19J�_, I, (We) ccu d as o principal place of r sidence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned _1�-��? �/% / Qo�,�
❑ are buying under contract G' ����Q -���• `�' 7O� -
❑ have a beneficial int�rest, in the taxpayer
Property Description
Taxing District (6+Fy-��ewa, Township):���--�--
Parcel Number
If buying on contract: Owners name "� ""'o1e °""e"
nty °� �Township
��''�—�a
or legal description shown on tax statement: �
pr,NiSuJs i�-s-ii . /��G�
Contract recorded in Recorders Office - Record No. Page
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:
certify the above statement is true, correct and complete.
County Township �
�L -��y ����.� ,�, �a �3 c��-� .�-�o
awre �l Street AEtlress Gry. Siaie antl Zi0 �e
' 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 �ne�acrei;imm�tei�
surrounding residenti imp vem�sds
Other Land
Total Land
�JN��1979
Residential improvement
�.�
,
Other Improvements
/�I/`,`X-Q^"" '�D w e I I i n g
i Garag �
RUD�vOR
Total
provements - Line (6) plus (7) equals (8)
certify the above is true. correct. and complete.
s . �� o� ��,
Approved:—
True Cash Assessed
Value Valuation
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- ACTION BY AUDITOR -
y�� �,�.
Homesiead
Valuation
�5 = i o - 79
Dare
Date: —�S�G�-_