Homestead_LucasFORM HC ID 1979
P�eSCriDeO By $Iate BaarG o� Taz Commi55ione�5
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19Z�
10 Be Filea in Duolicale
BACK FOR FILING INSTRUCTIONS �S �Q�OS !
� _ FJr
�(We) � � certify that on the 1st day of
arch, 19�2, I, (We) occupied as our principal place of res ence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
�, (we) f� owned �G- �� ,3�-0300 � lJd� �•7 `7`- O°�
❑ are buying • under contract ,
❑ have a beneficial irlt rest 'n the taxpayer �/ �J-�
Property Description, in__--*�1��tiJ County /"I�uud' .�..i Township
Taxing District ��e+w�--Township)'��J7-sc�^�..i
Parcel Number
If buying on contract: Owners name �'� �""we °""ef�
or legal d�scription shown on tax statement:
� sw � s w y ��-a-�� �i ��
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
���r��,��9 � .�4� � -3 CI%�
�fanature / SVeet Aoaress
County Township
e�-- , `.�..��----- �7GGa�
Ciiy. Seaie ana 2io CaCe
' Individual either owns or is buying under a contract ihat provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improv ents
Other d ({1l � �
Total L ,�nd �3 J
Residential Improve ent
JU�! � �79 Dwelling
/� Garage`�
Total
Other 1 A �ts �p�TpR
Tr� � Improve ents - Line (6) plus (7) equals (8)
I�,�y�l�ertify lhe� ove is�ru�correct. and complete.
/ I � ;
True Cash
Value
� i � S cro
(2) 5�J o
,3> 9 �v
�a� 02 v � a-v
(5� �
(6) �� (oa0
c�� � y9a (
(s) � / O
- ACTION BY AUDITOR -
Assessed
valuation
/7d
, d�r2$o
�" �i
3�cJ' y's°
Homestead
Valuation
S--/y-79
Da:e
Date: —�'� ��
7