HomeMy WebLinkAboutHomestead_Robinson (3)FOqM HC 70 7979
PreSCriDeG By State BoarE ol Ta� Commissioners
To & Piled in Dupliwte ` �
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS �S 'OI.SIY
�(We) � / I �J . ��� �• `�"'�� � � certify that on the ist day of
arch, i9 � I lWal nc:�i�niPA . rinr_.inal nlar_.a of reside the tollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)� owned
❑ are buying under contract
' O have a beneficial interest i
Property Description
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the taxpayer
Taxing District (Cii�-�ewfl, Township): //�� K
Parcel Number
If buying on contract: Owners name ��� simD�e owner�
���7 Township
ca�1c-1
��
or le al description shown on tax statement:
� �� s� � i9- a-ir i�GC�
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: �ounty Township
5� V " `
I hereby certify the above statement is true, correct and complete.
'// _ . /� �� _ � , /%� — A� � � .� -� %�,✓% i n ..
s�,�i
Ciry. State ana Zip
' 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 improvements
Other Land � � p � �
Total Land C�
Residential Improvements .,� j
��:,i 2 r. „, 9
�
Garage
L���� Total
Other Improvemen�' '
AUDITOR
Tn+ � Improvements - ine (6) plus (7) equals (8)
I��certify ihe above is,true. correct. and complete.
Dwelling
�lsxssoe
True Cash
Value
(�) S o 0
c2� l 9 .� o
(3) � � d
c4� a 9�'a
Assessed
Valuation
/��l (S
Homestead
Valuation
7
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Date
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Date: —(O