HomeMy WebLinkAboutHomestead_Mobley (3)�rescrilx�c3, By State Eoard of Tax Conmissioners
ClA1M FOR H(X�'�STEAD PROPERTY TAX CRmIT FOR YEAR 19_
I„�'�«ue) �
�h,!19 , I, (t•]e
zrty for cahich a
SEE BACK FOR FILING INSTRUCTIONS QOS ' OII %�
� certify that on the ls day of
�s our princinal olace of reside�ce the follaaing described real
Property Tax Credit is hereby �i*ra claimeri:
I, (T•7e) � awna3
� are buyinc? unier oontract
� have a beneficial i,�npteres
Pmoerty Description in �/ J�, �-
in the ta�ayer
Taxing District (City, Ta•m, ��mship) :
Parcel Pltmber
County
�//Jn .��+ l�G��-,�rce/3<l Tovmship
.-, ,u�., i � �
or legal descriotiors7shown on tax statenent:
��I�,� .3a- 3—ia . �//7�
,.
Z� buvino on �ntract: Owners name (fee sinmle ownes)
Contsact recorded in F�mrcier's Office - Recard No. Page
I� any portion of the residential structure or the land, not e�eeciiny one (1) acre that
imnediately surrow�ds that structure is used tn produce incane, describe the use acY3 partion of
the pn�perty utilized to produce income
. . . ,� .
s�a�T�
Pny other munties in which individual aans or is buying real pioperty: = Coimt �bwnship
T`��r�y certify the above staterc�nt is true, �rrFxt ani con�lete.
�u
*Signature Street Address -, City, State arri Zip Code
*Individual either ocans or is kuying uner a mntract that provides he is to nay the
property.taxes on the residence, or has a beneficial interest in the taxp3yer.
- FOR ASSESSOR�S USE ONLY -
Land not exceeding 1(one) acre inrtnediately
surrowriinq residential ic�rov�ents
�1 - . .
Total Land
P.esidential Imuoveme-nts
Dwelling
True Cash
Value
(1) ,-�iF»
(2)
c3> � �
�4> _1�
Garaae (5) '
��� c6� �'�D �o AO �0 8v
oth�r Irt�rovanents
c�� � � i
TQ '; Impn�vemPnts - Line (6) plus (7) equals (8) (8) i R a�-o � l0 0 g C� � ��
I he�seby certify.�he above is true, correct, and anmlete.
Assessed
Valuation
/7 �
�������/
�
I la�iestead
Valuation
i)at.e
- ACTION BY P.UDITnR -
aneroved: Date: