Homestead_GrigsbyFOflM HC 70 1979
PreuriEed By Slate Board ol Tax Commiuiancrs
To & FileE in Dupliwle
CLAIM FOR NOMESTEAD PAOPERTY TAX CAEDIT FOR YEAR 19� 5 I��q �
SEE BACK FOR� FILING INSTRUCTIONS W
�(We)-�yu-�� , ��� -�-� - certify that on the tst day of
arch, 79�Q, I, (We) cc as our principal� of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial iPteresf- in the taxpayer
Property Description i� ���^'
Taxing District j�i4y-�ea�n, Township):
Parcel Number
If buying Ofl contract: Owners name ��� simDle owner�
�1L-/� �4-/o�-Uoa, L9�- Q��
unty Township
---_•
or legal description shown on tax statement:
�. �i.<! � i 9- 3- ia , so
Contract recorded in Recorders Office - Record N
e
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, descrilie 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
0
' 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 ir�medi� �
surrounding residential �ro�ments
��s
Other Land
Total Land
Residential Improvements
v �,.�
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/
�; 1919_
e, ,
i
� � �. .�_
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Other Improvements
�T°� `improvements - Line (6) plus (7) equals (8)
�y certify the above is true. correct. and complete.
ot nisessor
True Cash
Value
c>> aso
(2) 6
c3> a .�- o
(4) / � O 90
(s) -
�s� / �' 0 9d
�,� — o —
�s� / �"0 9a
- ACTION BY AUDITOR -
Assessed
Valuation
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— o —
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Homestead
Valuation
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S-�/-79 .
Date �
Date: (rL(�/'/