Homestead_Smith (5)�rescribed. By State Bctzrd of Tax Comnissioners
CLAI(� FOR H(X�STFAD PROPERTY TAX CRmIT FOR YEAR 19_
� SEE BACK FOR FILING INSTRUCTIONS pS "a�� 1
I,�'Z��e) �_ -�J //�-� � �� v/2-�-nJ � ce��' �t on the lst day of
,+- h, 19 , I, (�'7e) occtmied as our prin�ioal olace of residence the following described real
r�arty for which a Hmnestead PropP�ty Tax CYedit is hereby being claimed:
I � (Y7e ) � ownsi
� are buyinc? under �ntract
� have a beneficial interes
Pronerty Description in _�� �� c �
�C /7-0� aoo-��CG9- ��/
in the ta�mayer
T�cing District (City, Twm, Zbwnship) : _��
?arcel ilwnber
� .YJ� � , � ` 7b�mshiP
�e� i
or lega�l descripti�on shown on tax statanent:
!�- �" /I � � u � — 3 — i � . 8� '�S-c.
Zf buvina on �ntract: Owners name (fee si�le owner)
Contract recorded in Femxder's Office - Recard No. Page
I_` any portion of the residential structure or the land, not e�eeciing one (1) acre that
ism�ediately surroturls t1-iat structure is used to oroduce incane, describe the use and portion of
the prooerty utilized to pn�duce i�ome
Pny other Wunties in which individual owns or is buying real property: = Co�- �•'nshiP
T
certify the above staterent is true, mrrect an3 co�lete.
*Zndividual eitt,er crans or is buying �er a cnntract 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 -
True Cash
Value
Iarrl not exceeding 1(one) acre inrtrediately
surmurriing residential u�rovanents (1) `�Oc� _
O`�he� Iand
To-�al. Land
?asid�ntial 7lmivve[�1ts
other Improvanents
(2) —
(3) � a �
Aaelling (4) 02 g 3/ C�
Garaae
'ibtal
(5)
(6) o�, ��/t�
(�)
7t1 '; Im?roverents - Line (6) Plus (7) �uals (8) (8) � �3/ L�
I nJeseby certi£y the above is true, correct, arxi crnrolete.
- ACTION BY PUDITnR -
vnD*_ov�: Date:
Assessed
Valuation
/�7f�
iianestead
�laluation
9-5�� �
Date