Homestead_Knowels (3)WqA1 HC 70 7979
PreuriDeO By Sute Board ol Tax tommiuioners
CLAIM FOA HOMESTEAD PROPERTY TAX CAEDIT FOR YEAR 19�
described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contraci
❑ have a beneficial interest
Property Description
�� /7 a,3-��-�� �7a-��/
the taxpayer
Taxing District (6itq-�e�a. Township): v�y
Parcel Number
inty � Township
.�iLrtl�/
Ar�
or legal description shown on tax statement:
f� S� =u 3 3- � a Y. 36.�, _
,—�
If buying Ofl contract: Owners name (�� s��"o�e owneq
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.
�� _ �l
s
County
Township
�
City. state afia Zio �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 residential improve ts�
_�A _ 5 1979_
Other Land
Total Land �/�('f
Residential Improvements ' '�
AUDITC�elling
Garage
Total
Other Improvements
Improvements - Line (6) plus (7) equals (8)
by certiiy ,the abq,ve is true. correct. and complete.
OI A55¢SSUe
True Cash
Value
(�) �: O�
(2) 'S' o—o
,3� 9 d o
ca) �r'y�
(5) -
(s) 9 � 30
(7 ) 35�D
c8) 9 7 �1 �
�[�RiP.� 1�p1
Assessed Homestead
Valuation Valuation
S-i�l- 79
— Da�e
Date: 6 ^ �J�' / �