Homestead_Goedde�rescribecl By State Board of Tax Conmissioners
CLAI�� FOR HOh'�STEAD PROPERIY TAX CRmIT FOR YEAR 19_
SEE
LING INSTRUCTIONS
po 5 -���
I, �'���+e) y��-^-Q �� ��J �� �2,.r��� oertif}' that on th= lst day of
�'--�h, 1� , I, (Ple) occLmied as our pri�ncioal nlace residence the following described real
���rty for which a Homestead Proppsty Tax �edit is heseby being claimed:
I, (T'de) � aanecl
� are buyinc? urzier oontract �lo - �� �°�`: ���- �G�• ��- d �l
� have a.beneficial interest in the taxnayer .
Pronerty Description in ��,��� County� .��m�. �.�. �_ Ta-mshiP
Taxing District (City, Tam, 7b�mship) : ��, .-._ A Q �
Parcel ihunber or legalUdescripti sknwn on tax statenent:
< YS �F' v /!> L-� sC /,5 =�-// /.�5,
I� buvina om m�tract: Owners name (fee si�le aaner)
Contract recorrled in RE�rrier's Office - Recard No. Page
If any p�rtion of the residential structure or the land, not e�eeding one (1) acre that
i�iately surro�s that structure is ussi to produce incane, describe the use ani portion of
the property utilized to pxvduce ir�ome
Pny other �imties in which irxiividual owns or is buying real prvperty:
I h_rehy certify the above statarent is true, Wrrect ani con�lete.
- Co� . 7b4mshiP
�
*Individual either v.ans or is buying imer a mntract that provides he is to oay the
orooerty.ta�ces on the residence, or has a beneficial interest in the taxpsyer.
- FOR ASSESSOR�S USE ONLY -
True Cash
Val�
Lairl not Pxcee�ing 1(one) acre i�nediately
surrowziing residenti.al i�rov�nents (1) ,`-j'O c�
Assessed
Valuation
/ � %�
Other Land (2)
Total Land ( 3) �'�/� f� /� C�
P,esidPntial I�rov�ne-nts p,aelling (4) /„ � /
Garaae (5)
��� c6� �y� /� ss 9� /� s� 9�
or�,� ��,��
c�� �
To '� Zmproven�nts - Line (6) plus (7) �uals (8) (8) 3� / �%D //i � 90 � /
Z h�eseby certify the above is true, correct, anl mm�lete.
i-�.� . _ „ , � i �
F�Canestaarl
Valuation
Date
- ACTION BY P.UDIT�R -
tworoved: Date: