Homestead_Simpsonwern xc ia isrv
Prescribed By SUte Boartl af Tax tommissioners
CLAIM FOR HOMESTEAD PAOPEHTY TAX CREUIT FOR YEAR 19 7 9
CTIONS
To & FiIW in Oupliwte
005' - 016 �i
'(We) �'�" ��-� /�
/
`�� �Township
or legal description shown on tax statement:
(� i 5 � � .�a - 3'- / / g'd a_..,...
Contract recorded in Recorders Office - Record
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.
F�� (�'/�n , � ///J
��"�+�C. `'\ • � S lyFsv �
'Signawre Sheet AECress � � ��ry: StOe ana Zio Coae
6-/��-7�
' 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 interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding �e� i ia�
surrounding residentia p ve e ts
Other Land
Total Land
JUN ? � 1979
Residential Improvemen �///uJ2�Dwelling
6s
� � Gara e
AUDITOR 9
Total
Other Improvements
Improvements - Line (6) plus (7) equals (8)
by�c�rtify ihe above is true. correct. and complete.
Approved
True Cash
Value
(1) J U o
(2) ��'.3.5 O 10�°�
�3> �
�a� �/yo
(5) / � -� B
�6� s� a
(7) / O �—D
�g� % j 5/ d
- ACTION BY AUDITOR -
�,
Assessed
Valuation
/ 7 O
Homestead
Valuation
S —/�'-7q
oa,e
170
Date: _--_�_/ _�_[_ �