Homestead_Luffwan+ xc io iern
ReuriEeC By State Bwrtl af Tae Commissioners
CLAIM FOA HOMESTEAU PROPERTY TAX CHEDIT FOR YEAR 19 �z-
To Be FileO in Duplicate
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� SEE BACK FOR FILING INSTRUCTIONS 0� 0����
' � ��� °"�." �s� �Q
��We) �� , , �• `� � �• i that o the 1st day of
�ch, 19 gyl, (We) occupied as our principal place of resid nce the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: S-I' 9� I�.�p
(We) Q'owned of[o - �7�0��0�0� C.e,v. ��� -���
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing District (Gity; Tew�, Township):
Parcel Number
If buying Ofl contract: Owners name (�� SimD�e owne�l
nty �°�"� Township
or legal description shown on tax statement:
Nw ��� i1/E % ia - 3 - /d /. �' �
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:
I hereby certify the above statement is true, correct and complete.
� —_ i �
County Township
ury, s:a:e am tip eoae
Individual either owns or is buying under a contract that provides he is to pay [he property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not 9xceeding 1 (onP) � �rr�dia� �
surroundin residentia� im ro e sL1 (�>
Other Land
7ota� �and MAY 1 p 1982
Residential Improvements �, �, elling
AUDITOR
Garage
Total .
Other Improvements
�=l�otal Improvements - Line (6) plus (7) equals (8)
�by certify ihe above is true. correct. and complete.
.. ,. _ .
Signawre al Fssessor
True Cash
Value
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(2) �{ o
(3) 55�0
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(5) —
�s> as9�o
(�)
�8� as9 �o
- ACTION BY AUDITOR -
Assessed
Valuation
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Homestead
Valuation
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Dz:e �
Date: