Homestead_MasonfOflM HL 10 1979
ReuriGeG By State BaarG of Ta+ Cammissloners
CLAIM FOR HOMESTEAD.PROPERTY TAX CREUIT fOR YEAR 19Z�
io Be Filed in Duo��cate
SEE BACK FOR FILING INSTRUCTIONS Q(�'O��OO
n
�(We) ������+ 1, ��h ���� �� K-���cl�� ,�ertify that on the 1st day of
��larch, 19�, I, (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) � owne�d .
❑ are buying under.contract ,
❑ have a beneficial iqtQrest in the taxpayer
Property Description i
Taxing District (6it�j-�evm, Township): !� /n�r�
"� Parcel Number
Ii buying on contract .Owners name �`� "tnp1e °""ef�
o?�- /e' /7 �o _ �a/. /aa- o�
/ /�/-���/'A�T_Township
� �
or legal description shown on tax statement:
f2..N�..Sf'%. /7–�–// S�a�-.
Contract recorded in Recorders Office - Record
Ii 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 utitized to produce income
Any other counties in which individual owns
(a�rtN�
�hereby certify the above statement is true, correct and complete.
County Township
C(�z/Y JvNn�saN
wture Sueec naaress ' Giry. Stare and Z�o �aae
�rrta. y ��, i95 y
' 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 -
� � � � � True Cash
Value
Land not excee ing ) diately
surroundin9 residential improvements (i� S—o-o
Other Land ���� "' i979 (2) la a�
Total Lantl� �
Residential Imprp,defn t A� Owelling
i
Garage
Total
Other Impravements
T'�' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Assessoe �
(3) l0 7 6 O
(a) �0 5�.�0
(s) — ° —
�s� lo �/30
(�) / S–s 7 0
(8) s�aZ O O O
Assessed Homestead
Valuation Valuation
�S' /5--79
Od:e
Date:���� � �%