Homestead_Ramsey (2)r�cru�ea-ny stace csoa:- .� ..crzmu.55��„��
CLAIM FOR HONESTEAD PROPERIY TAX CRmIT FOR YEAR 19 8�
EE BACK FOR FILI�y6 1NSTRUCTIONS �S -(��L�y�
I, `�,�e, �° �- � j CIIS�YlA3LL� �fy that.on the lst day of
h, 19 , I, (u]e) i as our princioal olac f�dence �ie followinq desc:ribed real
�'erty for wnich a H�nestead Pmpe=ty Tax 4eclit � ebS�Leinqg �a;.,re3:
I, (Tde) �v.msi . -o� �o' \
� are buyinq urrier contract ��_�Q o?�..�GY%-�� yy��J�
� have a beneficial interest in the ta�a�ayer
Pro�rty Description in Qe� 11� O��mty �o+JT6 omEky �mship
Taxing District (City, Twm, hip) •
ozrcel tiimine* or legal description sk�m on tax statarent:
pT Nu.,��y a� - �- �� a�..
I= buvina on �ntract: Owners rsme (iee simole ownPS)
Contract recorded in FE�n3er's Office - Record No. Page
If any portion of the residential structzire or the land, not e�eeding one (1) acre that
imnediately surroiurls that structure is used to produce incane, describe the use arid m,+ion of
tne orooerty utilized to pzoduce income
Pny other o�imties in which i.ndividual owns or is buying real property:
seby certify the above staterent is true, oorrect ani oon�lete.
Coim Rbwnship
City, State a� 2ip a
*Individual either vans or is buying tmer a wntract that pxovides he is to pay the
oroperty taxes on the residence, or has a beneficial inte-rest in the taxpsyer.
- FOR ASSESSOR`S USE ONLY -
Land not exoeeding 1(one) acre inmediately
surro�ling residenti.al i�rovarents
.�. .- ...
Total Land
P�sidential Iimrovements
Daelling
Garaoe
cl>
(2)
(3)
(4)
(5)
True Cash
Value
Sc� O
/ .fC
�O aS�
�L�--
_.
.
/��������
��������
i�nestead
Valuation
/ %O
Zbtal (6) i �SBo s$:o O .S$�o0
other 7ir�rovanents ( 7 ) i —.- /
Tc ' Ir¢�xvveirents - Line (6) Plus (7) equals (8) (6) /%.S&O .Sg�►p i
I hereby cPStify the above is true. correct, ani a�lete.
`�.mature of Assessor ��
- ACTION BY P.UDITnR -
e+oe�ov�' : Date :