Homestead_NellisFOf11A HC 10 19i9
PrewiEeG By Sta;e Board ol Tax Commissianers
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19�
io Be Filed in WO���ate
SEE BACK FOR FILING INSTRUCTIONS �S �o�aq 3
� �) FJ�Y
� �,,e %�� .��� �. ``' `T�� `G�.
�,( ) , i certify that on the 1st day of
March, 19�, I, (We) occupied as our principa6 place of residence the following described real propertyfor
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)� owned pJCO -�, �% /�-��0�7� ��/
❑ are buying under contract
❑ have a beneficial i terest in the taxpayer
Property Description in � Co�yun,ty �� -. Township
Taxing District (�', T^`•'^r Township): O/Lex-Z .
Parcel Number or legal description shown on tax statement:
.t �U �� �'✓(,�J �Y /7-3 /� a�/�'.
If buying on contract: Owners name ��� sfmole ow�en
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:
�hereby certity the above statement is true, correct and complete.
� _ G� /� . "1? _ /I//. �_ 12 _ . , , .. ,e O x= i
County Township
ana
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 residential improvements ���
Other Land ��
Total Land �
Residential Improvements APR 1 �0��9
� � Gara
. " A(/p�
Other Improvements R
T�Improvements - Line (6) plus (7) equals (8)
I-��,.��by certify the above is true. correct. and complete.
Signa:ure al
True Cash
Value
(�) Soo
�2� /070
(3) /S'70
ca> 3'1 S'v
(s) — —
�s� � 7 8 0
(7) —
�a) 3� So
Assessed Homestead
Vaivation Valuation
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/� - - ACTION BY AUDITOR -
� Y. �.r n,.�rn-.J Date:
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