Homestead_Harvey�
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Prtuii�N By Siale BW�O al iae CAmmissfaneR
oa 5- o35µo-o 0
. ' CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS � (�S�03S�
�e) ��"_"'� `� certify that on the 1st day ot
ch, 19�, I, (We) occupied as our principal place f residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)-4�'owned
❑ are buying under contract c�C-/� -c�s o?00 - GG3
❑ have a beneticial interest in the taxpayer
Property Description in . ` L'� County v
Taxing District (City, Town, Township): �� �
Parcel Number or legal description shown on tax statement:
In� . CU �'a i�E �'� a5 - a 1 a �•�O � L
�-��/
�
Township
It buying Ofl contrack Owners name ��ee simo�e o..ner1
� Contract recorded in Recorders Office - Record No. 5 Page zv�Q
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
certify the above statement is true, correct and complete.
County Township
. .:.. . . .. Streei Aadress . . Ciry'. 5�atr• ann zip Co�e
Individual either owns or is buying under a contract that provides he is to pa��
on the residence, or has a beneficial interest in the taxpa
,.
� - FOR ASSESSOR'S USE ONLY -
APR 141989
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land �
Total Land
Resideniiai Improvements Dwelling
Garage
Total
(�)
(2)
(3)
(4)
(5)
(6)
True Cash ssesse �,,, _ Hgr�estead
value ���d3l��OR�a uation
—�-
Othe Improvements ���
To�mprovements - Line (6) plus (7) equals (8) (8)
I he�eDy certify the above is [rue. correct. and complele.
Signatu�e ol Asseswe
- ACTION BY AUDITOR -
.,,
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