HomeMy WebLinkAboutHomestead_Glover (3)FOflM HC 10 7979
ReuriEed By State BoarC of Ta. Commissioners
Ta & Filed in Duplicate
CLAIM FOA HOMESTEAD PROPERTY TAX CREDIT FOH YEAR 19 � a
�
SEE BACK FOR FILING INSTRUCTIONS �rj-��
�{We)_ ��'�L; �-�-Q- •Q ����� ], � certify that on the 1st day of
arch, 19--, I, (We) occupied as our principal place of r i ce the following described real property tor
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial int�rest in the taxpayer
Property Description
Taxing District (City, Town, Township): /
Parcel Number
If buying on contract: Owners name i�� simo�e owner)
�G - ��-a�- �'oa - G�. G7�-��/
Township
or IegaY description shown on tax statement:
�� �/�J %u �� � ��-� -/a - . �O
, ,
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or ihe 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. Sute anC Zip 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(on�y adFe�llnAAi6t +}�
surrounding residential improvements
other �and �1AY 1 p 1g82
Total Land �� �.th�
Residential Improvements AUDI70R
Other Improvements
Dwelling
Garage
Tota�
Total Improvements - Line (6) plus (7) equals (8)
I;��y certify the above is true. correct. and complete.
SignaWre OI
True Cash
Value
(1) S O O
(2) —
(3) So 0
�a� a 3 S�o
�5> -
(s) a 3 ��-o
(�) —
(8) a 3 S �o
- ACTION BY AUDITOR -
Assessed
Valuation
/70
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—�-'ry � 0
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Homestead
Valuation
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Da:e
Date: