Homestead_Montgomery (3)FOflM HL t0 1979 .
PrescrioeC By Slate Bwrd ot ia. Commissioners /�Lw*' O7�/ �.�
L
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR
/ 9d-�3� ia Be FileO in Duplicate
1D V � ✓
SEE BACK FOR FILING INSTRUCTIONS S��a
�(We) / I `�'�"'� ' ' �-}�'='"`O �Q' �� � �'�'� �' certify t�hat on the 1�day of
arch, 19�.� cupied as ur principal place oi residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
�. (we) ❑ owned o�� �D -o�lo -/QO - CYJI ��3 - 4�-1
❑ are buying under contract
❑ have a beneficial interes m the taxpayer �y, �
Property Description in �-�-�-a-�� County /��x-�-��1- Township
Taxing District (City, Town, Township): %%�-an��-rn.��i--
Parcel Number or legal description shown on tax statement:
Px • �t.lW '�v� a 6 - � - / � / 4. S`a �..
If buying on contract: Owners name �'� s""ae °""e`�
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 certify the above statement is true, correct and complete.
/ � 1 • -/ ! �1.� °.5��'r��
County Township
ana zlo Coae
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 improvem� � �
Other Land � �
Total Land
Residential Improvements r�1AY 1 p 198�
welling
�e �UDITOR
otal
Other Improvements
Total Improvements - Line (6) plus p) equals (8)
I�by certify the above is true. correct. and complete.
_ _.
Signature OI A55¢SSOr
Approved:_
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
Date
Date:
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