Homestead_Mowrerwarn nc io is�s ,
HescriEeO By State BwrO af Tax Commissianers
CLAIM FOR HOMESTEAD PHOPEATY TAX CREUIT FOR YEAR 19 7 9
�arch, 19� I, (We) occupied as our(�rincipal place �dence��4ov
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) O owned ����1�'"
❑.are buying under contract .
❑ have a beneficial inZerpst iP the taxpayer
Property Description in
Taxing District (6iF�-3�ewa-Township):�
Parcel Number
If buying on contract: Owners na
To & FileE in DuDlicate
c�5 •���08
certify that on the 1st day of
ing described rea� oroperty for
�� i Township
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v
or legal description shown on tax statement: -
�tee simo�e owneq �jJ[p �
i. .S � � /
'- -S��-G�/.<
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• Contract recorded in Recorders Office - Record No. Page
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 certify the above statement is true, correct and complete.
',�:
Street Aaaress
County Township
Ciry. 5tate ana 2iv �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.
0
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding resitlential improvements
ootal Land � � � � �
Residential Improvements Dwelling
J��L 3 i979
Garage
� (����u,2� .Total
Other Improvements � AUDITOR
Tr'�' Improvements - Line (6) plus (7) equals (8) �
I��vy certify the above is true. correct. and complete.
Approved:
True Cash
Value
(i) � aZ�
�p� / a S C�
(3> / S'SJ O
�4, �a�o
(5) J 7 O
(6)_ �`f0
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
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Dare
Date: