HomeMy WebLinkAboutHomestead_Jennings (3)PoRM HC 10 1979
Prescri0e0 By Sia�e Bw�O of iaz Commissioners
To Be FileO in DuDlicate
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 19�� 00$77
❑ owned �/-�7-Jj�-��_c./� Q7� Q � /
❑ are buying under contract �O �� dY
❑ have a beneficial ipterest in the taxpayer
Property Description
Taxing District f6ily�owrt; Township): I"1�r
Parcel Number
If buying on contract Owners name ��ee s�mo�e
�� � Township
�
or legal desc�iption shown on tax statement:
�T� ,�-,� �-�-�a . —
�a� 5`9g3
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre that immediate�y 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:
�hereby certify the above statement is true, correct and complete.
�
County
Township
' Individuat 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.
- F R A SESSOR'S'USE ONLY -
�O1,Qnd � �
N"{�'YU j] True Cash
/ / ' Value
Land not exceeding 1(one) acre immedjatelp�n��
surrounding residential improveme�C�. � (�> S��
Other Land � � (���
Total Land � � � �3)�
Residential Improvements Dwelling �4) ����
Garage�
Totai
Other Improvements
provements - Line (6) plus (7) equals (8)
certify lhe above is true. correct. and complete.
(5)
(6)
Assessed
Valuation
CJ
Homestead
Valuation
• ' • ' �%�.��%%%%%/
• ��^ ���`__`:_ ����jjjjjjjj/
�������C�1�j��r��i�
App
s- //- 79
oaie
� 4
Date: � / 7 /