HomeMy WebLinkAboutHomestead_Robinson (6)FOPM HL 10 1979 ia Be Filea in Duplicaie
P�escriDeU By S�aie Boare of tax Commfssfoners
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CLAIM f0R HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�—
, � ) SEE BACK FOR FILING INSTRUCTIONS , /�5 ., O�GI �
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We)� �11�C.nU.��°' /l. V\D�^�� certify that on the 1st day of
rch, 19 `��, I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We)Ud'owned �� ��'�7 ��O—Ci:�• 7/.3 =���
❑ are buying under contract -
❑ have a beneficial interest in th taxpay,er � /�/� -
Property Description in _i County � �� l Township
.M r- _ .. -
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
Contract recorded in Recorders Office - Record No. � Page S� 9S
„�
or legal description shown on tax statement:
�.� . �W�`t 17-3-(( I,oaA
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:
certify the above .statement is true, correct and complete
County Township
�
' Individual either owns or is buying under a contract that provides he is to pay the pr�rt� f�i�` �
on the residence. or has a beneficial interest in the taxoaver.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements
Dwelling
Garage
Total
Other Improvements
T�mprovements - Line (6) plus p) equals (8)
I y certify the above is irue. correct. and complete.
$igndlO�E OI ASSP550�
�
True Cash
Value
(�)
(2��
(3)
(4)
(5)
(6)
(�)
(g�
- ACTION BY AUD�TOR -
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F,;�q!T c?
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Assessed Homestead
Valuation Valuation
Da:e
Date: � � �� � a /