Homestead_McClellan (4)FOFM HL IO 1979
PresceibeE By State Bw�C of ia. Cammissionea
io Be Filea in Ouplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 191�
SEE BA K FOR FILING INSTRUCTIONS ^w �' � 0��5�
`7-n� e-2=.-2.�.�._ .6— �— �,,.�,��5�,�-. �c.�.�
�(We) � certify that on the 1st day of
arch, 19'�_, I, (We) occupied as ou principal place of reside ce t e following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) ❑ owned qj� �� �� �'Q/J�oIo�9 Q�/
❑ are buying under contract
❑ have a beneficial inte es'�e taxpayer
Property Description in County 7%Lo-�.�-.+-s-r+.a�wi Township
Taxing District (Gity--�evr� Township): �-rn-t �
Parcel Number I I I I I I or legal description shown on tax statement:
�.,6. NE���c SE�% 8-3 —/z
If buying on contract: Owners name °� °'"'o�e ow�en .�°��v �s. TO
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
� hereby certify the above statement is true, correct and complete.
n
Aearess
Z�o �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.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding reside�al �rov�nts
Other �d �
tl
Total Land
Ialprov�meriYs!�
r=,r, �
uarage
� � Total
Other Impr ements AUDITOR
i�' Improvements - Line (6) plus (7) equals (8)
eby certify the above is„true. correct. and complete.
True Cash Assessed Homestead
Value Valuation Valuation
(�) �oo
(4) •f9 �Yo
16) �'!9�0
- ACTION BY AUDITOR -
�2 gr j�-a
.� -i�- �9
Da:e
Date: