Homestead_KeneippFOPA1 HC 70 7979 To & FileE in MDlitate
hewriEed By Siale BoarE ol Tae Commissianers '
CLAIM FOH HOMESTEAU PHOPERTY TAX CREDIT FOR YEAR 19Z
, SEE BACK FOR fILING INSTRUCTIONS QOS-�938
��We) ����—�� �, /!'/�-� % b� //- - certify that on the 1st day of
1Cfa�rch, 19 I, ( ) principal place of residence the following described real property for
which a H�tead Property Tax Credit is hereby being claimed:
I, (We) [�owned ��-/��a-/a� �. 9-� � o��
❑ are buying under contract '
❑ have a beneficial ' eres in the taxpayer
Praperty Description in County
Taxing District .�Gily--�e�un, Township): /'%'��
Parcel Number
If buying Ofl contract: Owners name ��� simpie owner)
Township
- v
or legal description shown on tax statement:
j�� �/w � � a-3- i a o. .� ��.
Contract recorded in Recorders Office - Record
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
�hereby certify the above statement is true, correct arid com ete.
r' ' � LGQ,c / �� �/ ����5
'Signeture � �. 5���� Aaa,eu �,��. 5�a�e a�a �,P �e
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' Individual either owns or is buying under a contr ct 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 exceeding 1(o acre immediately
surrounding residential im�e�ieri�' r T
� � �
Other Land j L .i..l j.J
Total Land JUN
Residential Improvements a 1979
Owelling
�� arag�
AU/�otal
Other Improvements
mprovements - Line (6) plus (7) equals (8)
{y certity the above is true. correct. and complete.
Il55PS50t
True Cash
Value
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(2) — ° —
�3� � 9 0
(al / g/ S� �
(5)
�s> / �/'�v
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(8) i� S�� O
Assessed
Valuation
�70
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Homestead
Valuation
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Date
- ACTION BY AUDITOR -
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PicJ Date: -�"�