Homestead_SelbyCLkIir1 FOR HO�riESTEN� PROPERTY TAX CAEDIT FOR YEAR 19�
. �' SEE'BACK FOR FILING INSTRUCTIONS �5 _p�S I�
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i•+ta'' 19 _, I, (`:�a pupiecJ as ou�ricipal place oi resi n�
w'r�i' Homestead Property Tax Credrt is. hereby being claimed:
I(1,Ve) oWned �r �. � �. o a s o � S 9a.,
❑ zre buying under contract - ��-/O-�j—�a,�i��r9� O P�
. ❑ have a beneficial i� n�rest in the tax pa yer .
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certily .thal on lhe 1sl day ol
the following described real property for
. Property, Description in � ��� /-�%-�?�J'
i
Taxing District, (City, Town, Tovinship):
?arcel Number' ;
If buying on contract: Ovmers
Contr
li arry portion of the residential
sEructure is used to produce ii
Any o�her counties in which indivic
I.'��reby certify ihe above stat?n
�lee simole owneq
unty
Township
or legal descripiion shown on tax slatemenl:
?��.�5�'/�� .3� - �-ia - � � �� �a:e. .
recorded in Recorders Of(ice - Record No Page
ucture or the land; not exceeding one (1) acre thal immediately surrounds Ihal
me, describe the use and portion of the property ulilized to produce income
ual owns or is buying real property:
ent is true, correct and compiete.
Counly
Townsliip
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� . � Slreet ACG�ess � � � C�IY. 9aie anC Lo CuJc
Indiv�r;ual either owns or is buying under a contract that provides he is lo pay the properly taxes
o� tpe residence, or has a beneficial interest in the taxpayer.
�.
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� ` - FOF± ASSESSOR'S USE ONLY -
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����� r- True Cash Assessed Homestend
i�}
r�d oo� excee in �i:qo�e�9�Cre immediately
rrounding sideniial im rovemenfs
her Land �DITOR � s �,
i(al Land � t
,
�cidential Improvements
Dwelling
• � . Garage
; � Total
hEr.!���rovemenis ,i
i :��ta'. ., rovements - Line (6) pius;(7) equals (8)
nere�y certiiy Ihe above is lrue. correct, and complete.
(U
(2)
(3)
�a�
(5)
(6)
(�)
(4)
Value
::almc al Assesso� . '
/f }� - �¢�WC}f� ,$Y AUDITOR -
/ (/li(/Y1.C,- !J- .7° �
Valualion Valuation
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