Homestead_Scott (6)FOFiM HC i0 �979 to Be Filea in DuD�icaie
NeuribeE By Sta�e Bw�G of Ta. Cammissionea ,
�i y 8' 1
CLAIM FOR HOMEST,EwAD PROPERTY TAX CREDIT FOR YEAR 19Z �y���.,(���
crr on7t'�£rin rii �n�r �ucTn� i�T��N$ oOs� �'�M+ •I
March, 19�, I, (We) occupieciids our pTincipal place of resideQi�
which a Homestead Properry Tax Credit is hereby being claimed:
I, (We) � owned
❑ are buying under contract
❑ have a beneficial int�r�st in the taxpayer
Property Description
Taxing District E�..ity T����^ Township): ,�'J : s
Parcel Number
If buying Ofl contract: Owners name ��ee simv�e owner�
�� certify that on the 1st day of
the following described real property tor
a�-�Q-a�-�� - ������ o��
;ounty �� e�-.-/ Township
or lega—� I descriptiOn shown on tax statement: as,qa6 •
� S[.�J � S GcJ '<�.t o'� G' 02 —/ �2 �
Contract recorded in Recorders Office - Record No. Page
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: County Township
�hereby certify the above tatement is true, correct and complete.
_ /% . ,�% G� � �i` 7 6 6 �
id��� •
.-
'Signai e Scrrei AOdress Crty. State ana Lp CoCe
' 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 inierest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
FILE1�
Land not exceeding 1(one) acre immediately
surrounding resj�2,�i� ��9�ments
IrIH /
Other Land
Total La�
i
Residential I ovement�q�
Dwelling
Garage
� Total
Other Improvements
T Improvements - Line (6) plus (7) equals (8)
I�by�Certify the above is t,5ue. correct. and complete.
Sigm:ure
True Cash
Value
(t) .} o 0
�2) 79 i v
(3) g � �
(a) � /7U
(5) S 8�0
(6) s���
(7) �lo lol�
�g� �'f / Q
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
7a
.5=/8-79 ,
oa:e ' �
Approvetl:� ��� /%� Date: jL����p � 4