Homestead_Harringtonwun xc io �s�
PreuriDeE 0y Sute BoarE of Taa Commi55ioners
To Be Piled in Duplicate
CLAIM FOR HOMESTEAD PflOPERTY TAX CREDIT FOR YEAfl 192� �0-�S 3
SEE BACK FOR FILING INSTRUCTIONS �O� •
�We)��� ��d____L� ��' �QL�« ^�,—�1 - certify that on the 1st day of
nnarch, 19�, I, (W occupie s our principal place ot residence the following described real property for
which a Flomestead Property Tax Credit is hereby being claimed:
I, (We) O owned
(� are buying under contract
� have a,beneficial in rest in the taxpayer
Property Description in
Taxing District �r.�ewrr,-Township):
Parcel Number I I I I
If buying on contract: Owners name ��� simple o.�e,�
c�� //-030 -0�00 -Q40. 7�� ��
nty Township
or le al description shown on tax statement:
��z,G(/�� 3 o-a-�i / �'PS—
Contract recorded in Recorders Office - Record
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:
�ereby certify the above statement is true, correct and complete.
�i�.�.� ���,,� �,�.�
County Township
CoOe
' Individual either o�ins 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 immeprpTelr ���
surrounding residential improvements j� j
Other Land
Total Land
Residential Improvements
Other Improvements
JUN s is�s
��wellin
' /����UC�T `
Total �
,��'mprovements - Line (6) plus (7) equals (8)
°� y certify the above is true. correct. and complete.
Assessar
True Cash Assessed Homestead
Value Valuation Valuation
( � ) S o-�o / 7 d
c2� v vo Yo1.-.�
c3� 9 � o a,
�a> % o 0 0
(5) � % 9 U .
(6)/D 7 5' O
(�) — ° '
�g� /O 7 9a
—�O
�
�-i/-79
Da:e