Homestead_Smith (10)PoflM HC 10 7979
Prescri�eJ By Sta�e BoarC ol iax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 9
io Be Filed in Duplicale
SEE BACK FOR FILING INSTRUCTIONS �5 -0(66 I
. � , _ . .
�(We} � %�-� � certify that on the 1st day of
�v�arch, 19._?_�. I, (We) occupied as our rincipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: ��� � �
I, (We)� owned . — c��W(
are buying under contract p �. QD� �� Q�/
❑ have a beneficial in erest in the taxpayer p�—r? 0�a ,
Property Description in �-s-�,J County A Township
Taxing District (C�� r.,....,. Township): ��� �—�
Parcel Number
If buying on contract: Owners name �'� �'"'o'� °^"ef�
or le al description shown on tax statement:
/'�.� �- 3 - � a. . �"�a--
Contract recorded in Recorders Office - Record No
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 the property taxes
on the residence, or has a beneficial interest in the taxpayer.
�7i]:�F�9��YU:RY��Y�il�i�al
Land not exceeding 1(one) acre i�� medj�ly �
surrounding residential�pr�eme�Fjs ��
Other Land ��
Total Land � � i979.
.1LNi.
Residential Improvements /������d/�Iling
��� 9e
/ AUO1T�CIft�tal
Other Improvements
?^"' Improvemenis - Line (6) plus (7) equals (8)
.�:§y certify the above is true. correct. and complete.
AS32S50!
True Cash
Value
�, � �i'3 0
(2) _ c
(s) S�3 a
�a� 51 YSo
(5) ,3 S! 7 c)
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(�) — ° —
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Assessed
Valuation
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_ 74?°
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Da:e
Homestead
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- ACTION BY AUDITOR -
Date: � � 2