Homestead_Meeks� FOHM HC 10 1979 � To & FileE in Duplicate
ReuriDM By Sute Boara ol Ta. Cammissioners
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CLAIM fOR HOMESTEAD PROPERTY TAX CflEDIT fOR YEAR 19 �v
SEE BACK FOR FILING INSTRUCTIONS ��'�/ /
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=�(We) ��- N�a �' ���� �• certify that on the tst day of
rch, 19�,�, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned G,?G_/o -aG_��-�/. /G� ��-/
❑ are buying under contraci
❑ have a beneficial interest�i/n the taxpayer '
Property Description in /�"-�-�-n-�"� County �5�"�� Township
l�.-. � �J .
Taxing District (City, Town, Township):
Parcel Number
If buying Ofl contract: Owners f18fT1Q' ��ee.simple owner�
or legal description shown on tax statement:
�d rC �i itJ E�/'� 3-G - a-/ 3- /• 3�7
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: County Township
I hereby certify the above statement is true, correct and complete.
: � 1 � / /1-�-�-�'�
•Sionamre Sveet ACareu
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
Other Improvements
Dwelling
Garage
Total
Total_Improvements - Line (6) plus Q) equals (8)
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!��y certify the a`bove is true. correct. and complete.
Signawre of Asseswr / /
v
True Cash
Value
(1) SO o
(2) 8 0
(3) o� 80
�a� �Soo
(5) —
(6) �SOo
Assessed
Valuation
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(�) �i`�"
(a) �fSo o f�"�
- ACTION BY AUDITOR -
Date
-�
Homestead
Valuation
,! Zo
�s__-+�.�
Approved: � Date:
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