Homestead_Pegram (4)FOI7M MC 10 1979
Prescri�ea By S�a;e Boara ot ia� Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
io Be Filea in Ovplicate
oo5-d(38 �
�� (we) ��--E�/�-r�, �P�z�L °l � l �r.:f�O� �__ certify that on the 1st day of
��larch, 19 �9 ,(We) occupi s our pri ipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: "
I, (We) O owned ��7�%T _ dG—(� y. Ja[� - Q�
❑ are buying under contract
❑ have a beneficial in res in the taxpayer
Property Description i
Taxing District .(.Gitq-��ewFl- Township):
Parcel Number
If buying Ofl contract Owners name ��ee simoie owneq
� °� ,-��-��/ Township
.�.. _i
or legal description shown on tax statement:
�l.�l�S'� � 5� 3-ia �S�v
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:
J
�hereby certify the above statement is true, correct and complete.
County
Township
' 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 ON�Y -
� � � �j � True Cash
Value
Land not exceeding 1(one) aQ�`jm�e���lq�
surrounding residentiai improvements
Other Land ��
Total Land � AU/�
Residentiai Improvements
Dwelling
Garage�
c�) � o 0
(2)
(3)
(4)
(5)
Assessed
Valuation
Homestead
Valuation
/70 /7v
Total (6). � / a 7 U
Other Improvements (�) _ _ % �9�
? '^� Improvements - Line (6) plus (7) equals (8) (a).��.�.�<D
I�aby certify the above is true. correct. and complete.
�Sigmmre ol Assa7wr� "
. O - ACTION BY AUDITOR -
App
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