Homestead_PowersFOflM HC 10 1979
Racri0e0 By State BoarE ol Taa fqmmissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19Z�
SEE BACK FOR FILING INSTRUCTIONS
To & PileE in WD���ate
oos-dy�o
�(We) �� �-'�' certify that on the 1st day of
.2rch, 19��, I, (We) occupied as our ' cipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) � owned a� -�� �/-p�00��i�. /�� - �a"/
❑ are buymg under contract
❑ have a beneficial ��inC)�e/r� st in the taxpayer
Property Description in �,��—�-� -�-� County _
Taxing District (CYtp� �ewn, Township):
Parcel Number or legal
Township
ription shown on tax statement:
5�.� �1/� y ai-3-iz /.75�9�
�
If buying O!1 contract: Owners name (�� ��"o�e owner� _
Contract recorded in Recorders Office - Record No. Paqe
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:
�hereby certity the above statement is true, correct and complete.
County Township
i • ��
' 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 [axpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immedi�fy
surrounding residential improvements
Other Land
Total Land
Residential Improvements
/�
_,
� y�.�. +� �
; �' • �
. .
.
: � � .
�, • �„ '' • ' ���������
J � � jjjjjjjj�/.
. � • i�y
�
Homestead
Valuation
Total � > � � � � � ° ��
Other Improvements (�) ° — ��
To� � Improvements - Line (6) plus (7) equals (8) , (8) /� � "%� �d
I�5y certify the above is true. correct. and complete.
01 ASSPSSOf
�5 = /G-79
�a;e
- ACTION BY AUDITOR -
cJ Date: !D " �o " �9