Homestead_JenningsFOFM HC 10 1979
Preuri�e0 By Sta�e BwrE af Tax Commi55ioner5
To & FiIW in Duplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19 g� p q
SEE BACK FOR FILING INSTRUCTIONS OpS � 0007 /
,(We) . . • K
March, �� I, (We) ccupied as our principal place of residence the
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) O owned
❑ are buying under contraci
❑ have a beneficial interest in the taxpayer
Property Description in
Taxing District (City, Town, Townshiol:
Parcel Number
If buying on contract: Owners name �'� �'"'v'e °""e`�
ify that on the 1st day of
described real property for
�G/7-�/- �'a�-�a'�• �7S'-D-�1
C� i�" /'1iQ� 'S�vv,-•*�-<./ Township
i
v y /�
or legal �criptioo show,p �taac stateme�rt�,�Z �•-
^ nw.....�..r+—•�J`—� � ' ! ��/� 3
� 11 r— n i n i� n 1 F%� J_ �- i 2 �-�-r1'�i-'-
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
`�ereby 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.
�Yi]:��Y��Y�7:iF�i�b9�i]il�!
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land �°!�
Residential Impr6�m��� �
1�.
Dwelling
� 198� Garage
f^��( 7 Total
Other Improver7�s �(�/ _ y""
G/S � L/�t1[diL.�/'l
Tr' 'mprovemen� - Lint�����q (7) equals (8)
�.�oy certify the above is true correct. and complele.
ol Assessor
True Cash
Value
(1) so-c
(2) - ° -
(3) So ,o
�a� a a, ��o
(5) �-`�°�
(6) � �`��D
(�) �
�8� a,a Sso
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
S —/ a — 8 O
Da�e
Approved: Date:
� �