Homestead_Schmidta�^'''�°� CLAIM FOR HOMESTEAD PROPERTY TAX � EaR
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INSTRUCTIONS: See reveise side 7oi /iling insfructrons.
� CERTIFICATION STATEMENT �
place of resi nce the following described real property for which a Homestead Pmperty Tax Credit is hereby claimed:
` I(We) owned ❑ Are buying under coniract
❑ Have a beneficial inierest in the entity thai is liable for the property taxes on the property and that owns the property or is buying under a contraci.
. - CONTRACTRECORDED �
If buying on contraci. Fee Simple ownefs name . .
Recorder's oHice where comract is recorded Fecortl number Page
Coun�y
PROPERTY DESCRIPTION -
Taxing diSMci 1c' fown, tOwnShip) �
J
r-kA0
Parcel number � Legal descriptio �
C1�5-as'{8����: �- S- P�IcJ I�-3-r a.���
If any portion ot the residential strucmre or Ihe land no� exceetling one (7 � acre that immediatety surrounds ihat siruciure is used ro produce income, describe the use arW portion
oi �he property utilized to produce income.
�
- / 9 /lo - /Oo -GY>/. �5�d�- ��/
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately
surroundinq resideniial improvements. (�)
Otherland (p)
Totai land (line 7 plus line � (3)
Dwelling (4)
fiesidential improvements
Garage (5) -
Other improvements (6)
Total improvements (line 4 through line � (7) f
Total value (line 3 p�s line � (g)
I hereby Geriify ihe above is irue, correCt, and Signawre of Assessor Date signetl
wmplete.
Veritying aaion - Siqnature of Auditor Date signed
ALLOWANCE
79_Pay79_ (
Lesser of ll2 Homestead
Valuation or 52.000 5