Homestead_Pegram (5)FOflM HC 10 1979
Prescri�eG By S�a�e Boa�O al 7a. CommissianeR
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19 9
siden
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) � owned
❑ are buying under contract
❑ have a beneficial � tefest in the taxpayer
/ //
Property Description
Taxing District (Gifyc-�ewfl- Township): /'h-�
Parcel Number
If buying on contract: Owners name ��� simple
io Be FileC in WDlicate
vs MS p(38g
t.J�+�
%--- certify that on the tst day of
following described real property for
01� /7 DP- a�oD -C�/. .���� O°�/
� Township
a _ -�
:�' .
or legal descripiion shown on tax statement:
i�- S� � � .3-�a �
�s�,��
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 and complete.
�...t G �u,��D�v �..
'Signamre SVee� ACC�ess Giiy. 5•�en0 Zi0 �e
' 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 taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residenti�p��nt� �
Other Land
Total Land
Residential Improvements JUN 221979 Dwelling
,�% �/�r�� —{�- Garage
�/f 7� �Q-��yit� Total
(� AUDITOR
Other Improvements
T�• ' Improvements - Line (6) plus (7) equals (8)
t�� certify the above_is true. correct. and complete.
True Cash
Value
(t) � O o
(2) I 7 � o �
�3� � � a o
(4) J FS o—v
�5� a 7 d
s
Assessed Homestead
Valuation Valuation
Z:
i ' . . . _- : �
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, • � � ---��%%%%%�%%%
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5 =/�-79
Dare
Date: _--l1�����