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CLAIm FOR HOMESTEAO PROPERTY TAX CREDIT FUR YEAA 19�
SEE BACK FOR FILING INSTRUCTIOIJS �-
�, �? 1\UV Vl/� li���'" C.�-�''Y[�tX��� �.CJ.C.(_DI.C`� _ ccrlily that un the 15l day of
Ma 19 I, (We) occupied as o principal place of resid ce lhe lollowing described real pioperty (or
which a Homestead Property Tax Credit is hereby being claimed: ,
I, (We) [�owned Q%� - �O .�� �QO -QQJ• 7Q� Oo��
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in County �� Township
Taxing District (City, Town, Township):
Parcel Number' or legal descriplion shown on tax statement
c��� -� �►�Zval� / 7-3-1 �.��
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If buying�vn contract: O�ers name
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Contract recorded in Recorders Of(ice - Record No. Page
� G. .
If any portE'Orn�f�h� }es�ential struciure or the land, noi exceeding one (1) acre that inunediately surrounds that
structure is used to produce income, describe the use and portion of the proE�erty ulilized to produce income
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Any other counties in which individual owns or is buying real property
I��by certi(y the above slatement is [rue, correct and complete.
Sveet Aaarev
County Township
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Individual either owns or is buying under a conlract lhat provides he is to pay the p�opeity taxes
on the residence, or has a beneficial iMerest in the taxpayer.
- FOR •ASSESSOR'S USE ONLY -
_and not exceeding 1(one) acre immediately
>urrounding residential improvements
)iher Land
�otal Land
3esidential Improvements
Dwelling
Garage
Total
Other rovements
Total rovements - Line (6) plus (7) equals (8)
I hereby certify the above is true. correct, and complete.
ffiqmwro ol /astsso�
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True Casli
Value
(�1
12)
(3)
�4� _- -
�5, _
�6)
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- ncTioN BY �u�rroF� -
F1SS(?SSCC�
Valuation
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Homestead
ValualiOn
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