Homestead_ShackelfordweM Hc io �e�
PreuriGea By State Boam a� iaz Commissioners
io Be FileO in Duo���a�e
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 19-� 9
SEE BACK FOR FILING INSTRUCTIONS ..e.0 ����pO I
�Y
�(We , � certify that on the 1st day of
March, 79��_, I, (We) o cupied as our principal p e of resid� e the following described real property for
which a Homestead Property Tax Credit is hereby being claim d:
(We) ❑ owned
❑ are buying under contract
❑ have a beneficial in�st�
Property Description
�� -/� /�/�G- G�Q!��/- ��/
the taxpayer
Taxing District (eity, Tvwrr, Township):�Lv�
Parcel Number
If buying on contract: Owners name ��ee s�mo�e o.�en
� Township
��
o� al description shown on tax statement:
-{� �.� NaJ�, �s�-3-�� /�.
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 statement is true, correct and complete.
Individual either owns or is buying under a contract that provides he is to pay ihe 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 5�i
Other Land ..��p � � klil _�
Total Land •� �8
Residential Improvements ��N 2 h ig79 Dweliing
rage
�� a�
AUDITOR
Other Improvements
T�Improvements - Line (6) plus (7) equals (8)
I�. ab} certify the aboye is irue. corr�ct. and complete.
/155C550�
��� � •� ��I1�
True Cash
Value
(�) .'� a o
(2) — � —
(3) �j D �
(4) 7 Tr'.�-0
�5� — o —
�s� 7 9�0
1�55��
�g� � � y�
I�I\��lt�l l l�l��
Assessed
Valuation
� 70
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i
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Homestead
Valuation
�S = / 7— Z�
Date
Date: �i�—