Homestead_Hale (5)FOflM HC 10 1979 To & Filed in OupliWte
Preuri�e0 By S�ate Baartl a� Tax Commissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAH 19 ��
SEE BACK FOR FILING INSTRUCTIONS pps�� 33
��vJe) /S[g_DP �; �-P��-�-/ ,� • � ���1�-� � certify that on the 1st day of
March, 19_� I, (We ccupied our principal place of residence the following described real property for
which a-Homestead Property Tax Credit is hereby being claimed:
I, (we) ❑ owned ��- �%/ %-�GYJ - OGY� %j3 -O��
❑ are buying under contract
O have a beneficial interest in the taxpayer
Property Descriptian in �_�M� c� C�o,unty Township
Taxing District (City, Town, Township): ��—o�fi-�����/
Parcel Number or legal description shown on tax statement:
�-: �t���-%a�y �i7-.�-i a l /d�
If buying Ofl contract: Owners name ��ee simple owneq
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: County Township
�iereby certify the above statement is true, correct and complete
' 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 immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements
True Cash
Value
( � ) .Sa o
(2)
�3� So 0
Dwelling (4� � � 90
Garage
Total
Other Improvements
T�Improvements - Line (6) plus (7) equals (8)
I by certity the above is true. correct. and complete.
, ,�, �-, „
Signamre ol
- ACTION BY AUDITOR -
Assessed
Valuation
� 7d
/ %o
����%��%�/%/�
.� � �
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_ ' _ � /�jjjjj/�jj
Homestead
Valuation
/ / O
.5 �$� ��
Da:e
Approved: Date: