Homestead_Ping (2)I, �'-��e)
h, 1
�n`rty
I,
CLAIh1 FOR HOP'�STFAD PROPERIY TAX CRmIT FOR YEAR 19 �y
SEE BACK FOR FILING INSTRUCTIONS QD S'O�y07
GtJ,t,Q,�,C,a.ry- 1�- �C�r�. cestify "that on the lst day of
) occ�roied as our principal ola of residence the follaaing des¢ibed real
a Hmnestead ?roperty Tax �eclit s heseby being claimed:
I , (S�7e ) �'aana3 .
� are buyinq under contract
� have a beneficial int
Pro�rty Description in
Taxing District (City, Twm, Zbwnshi
�G - �6 -aC-d3GG- �G� 5o � ��
in the taxnayer �j'�� �-
� j Cotmty / I �.er1�-� �t,� 'ithm5hip
n�ol p»r or legal d=scriotion shown on tax statares,t:
�, �u���� �b�dt- I Z
Z� buvina om m�tract: O.aners name (fee siz�le own�s) �� ���
Contract recorded in REmrder's Office - Recnrd Ab. Page
If any portion of the residential structure or the land, not e�eeding one (1) acre that
imnediately surroiuris that structure is used tA produce incane, describe the use azr] �*+;an of
tne property utilized to produce income
Pny other mimties in which individual owns or is buying real pxoperty:
certify the above statenent is true, wrre�t and co�lete.
COlII1tV �Jv7l15Y71D
nature S�eec r3cxu:ess •..��s , •.•....... �.-. ,
*Zrxlividual either owns or is tuying imer a oontract that provides he is to oay the
property taxes on the residence, or has a beneficial interest in the taxosyer•
- FOR ASSESS(�2�5 USE ONLY -
Ia� not exceeding 1{one) acre iucrtriediately
surrounding rasidential i�rova�nts
,�.^iR3ii.TiT:I
Total Iand
P,eside�tial I�rovm�e-nts
Lxaellinc7
Garaae
Toral
True Cash
Ualue
(1) SOo
(2) __yfl
c3> S3o
c4� /7/Sfl
(5) �
c6) /7�So S7a°
Assessed
Valuation
�%O
ilanesteacl
Valuation
othes 7�rovanents
(7) "'� �
Tc '. 7�rov�ients - Line (6) plus (7) e�uals (8) (8) /� �So �
Z hereby certify the above is true, carrect, and oacrolete.
Dat.e
- ACTION BY u.UDITnR -
�oroved: Date :