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WflM HC 10 1979
Reuri6ed By State BoarE of Taz Commissianers
lJ
To & FileO in DuD���ale
CLAIM FOR HOMESTEAD PAOPEA7Y TAX CREDIT FOR YEAR 19Z� .
SEE BACK 'FOR FILING INSTRUCTIONS . �S � �o��
�We) , hat on the 1st day of
�rch, 19�Q, I, We) occupied as ou incipal place of reside e the foll ing described real property for
which a Homestead Property Tax Cred is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial i�yterest,in the
Property Description
Taxing District (�i�y-�ew�—Township): �}�iS�s
Parcel Number
If buying on contract: Owners name ��� sim0�e owner)
a��-/7 � 3 - �"oo - �. dn� �-O��
nty � � �r Township
L�9�1�.c.� - .
r legal description shown on tax statement:
�S£� 3_ 3-/1� o'C,5//
sc E� 3-3-�� F.7o 6L..i.-
9 � �l
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 buyin9 real property:
hereby certify the above statement is true, correct and complete.
u
�
County
Township
r
ve ��J / Sheet Atldress � " �-Ciry. State antl Zip Code
E VV
�--��-��.
' 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 e i one) acre immediately
surrounding�d�ti�imp�q er}�17ib
Other Land L �+ � i�
Total Land �'�,� j i979
Residential �provements
vi � �
�/- �
r/ AUDITOR
Other Improvements
Dwellin
Garage
Total
•.improvements - Line (6) plus (7) equals (8)
,by certify the above is true. correct. and complete.
ol
True Cash Assessed Homestead
Value Valuation Valuation
(1) S o 0
�p� � o 0
c3� / 5/Q a
c4� a13 a-s o
(s)
�s� � 3� S a
c�> o� 0 9a
�g� � S'.3 5�0
- ACTION BY AUDITOR -
��
�—//-79
Date
Approved:��i -�-� OaX2,� ' Date: �• �9 �7i�