Homestead_Jochim (5)` .,. CLAIi�i. F0A NOiriESTEAO`PROPERTY TAX CRE�IT FOR YEAA 19-/v „ �__
• � S�t BACK FOR FILING INSTRUCTIONS �CJ�p30I�
I,; (4fe) � �' 1� ��j � , certify .that on lhe 1st day ol
AAe?h,�i9 , I, ('Na) accupied as our priricipal pl e of residence the foilowing described real property for
whi . Homes� ad Property. Tax Credit is. hereby being claimed: ^ '
I, (W.� owned . GY�-�����OO-Q�J�.O/�D�
L7 are buying under contract -
�� have a. beneficial inlerest in the_ taxpayer .
Property. Description in County
T2xing District (City, Tovrn, Township):
Pzrcel Number' or Iegal description shown on tax statemenL
- -. ; - -. _L_°� �-�,�r�ILI _���-�-�a, •���,
�i buying Ofl COfli� � l�ee s�mv�e ow�eq � ' " � � - : :
rded in Recorders Of(ice - Record No Page
If any portion o( the i e �ial `�}{cture or ihe land, not exceeding one (1) acre that immedialely surrounds thal
structure is used to ����i�o'Me, describe the use and portion of lhe property utilized.lo produce income
, �� �d �O/�
'� Township
Any ofl�er counties in which individual owns or is buying real property:
I,��reby certify the above statement is lrue, correct and complete.
� i
S�reel ACaress
Counry
Townsfiip
ciy. si,ie ���a z�o eu�c
Ind���dual either owns or is buying under a contract that provides he is lo pay the property laxes
o� tbe residence, or has a beneficial interest in the laxpayer.
- FOFi ASSESSOR'S USE ONLY -
g
nd no� zxceeding ��:!(one) acre immediately
rroundin9 resideniial improvements
her ! and
tal Land.
sidential linpro�:ements Dv�elling
Garage
Totai
(�)
(Z)
(3)
(4)
(5)
(6)
True Cash
Value
hEr 'mprovemenis ��1
?ta: �;vements - Line (6) plus (7) equals (8) (8) _
here�y certiiy the above is true, correct, and complele.
namrc ol nssesso� ' '
n, - , �`M ; ,n ; _ - ACTION BY AUDITOR -
vvhnlY- �c_��Y
Assessed Homesle�d
Valuation Valualion
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