Homestead_Higginbotham (2)wan+ xc m iem
Preuribed By State Bwrd ol Tar Cammissioners
� CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
Ta & Filed in WDlicate
„nrf.�o�.r�z�cfv� �
005 -oH5�9-�
(� � SEE BACK FOR FILING INSTRUCTIONS L
�(We) `• "-'�� � V��^^�O� , certify that on the 1st day of
�arch, 19 I, (We) occupied as our prin ' I place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned ,
�'-/7 aa-��-ao���j9-a�✓
❑ are buying under contract .
❑ have a beneficial interest i_n nthe taxpayer
Property Description in ��'�' ` County I''� ' Township
Taxing District (City, Town, Township):
Parcel Number or nlegal description shown on tax statement:
lY� .�1,,� %t �- 3- i� 51� • l� 3
If buying on contract: Owners name
Contract recorded in Recorders Office - Record No. —S Page `i38S
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 Towns� .
MA� n l�n
�hereby certify the abofe statem ' true, correct and complete.
� � A' Y12LacI�S
�C, � � �f N'S�� IP ��1 AUD��ITOR �
'Signa�ure SVeet /OEress Giry. State anE Zip CoOe
' 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 exceedinq 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements
Dwelling
Garage
Total
(�)
(2)
(3)
(4)
(5)
(s)
True Cash
Value
Other Improvements (�l
T �mprovements - Line (6) plus (7) equals (8) (8)
I ;oy certify the above is true. correct. and complete.
Sigruwre o1 Assezmr
- ACTION BY AUDITOR -
Assessed
Valuation
oace
oate: 3'l0 -g�]
Homestead
Valuation