HomeMy WebLinkAboutHomestead_Smith (13)FOFM HC 10 7979
NestdDeE By Siale BaarO of iax Commiuioners
To Be FileO in DuDlicate
CLAIM FOR HOMESTEAD PROPERTY TAX CAE01T FOR YEAR 19 7 9
SEE BACK FOR FILING INSTRUCTIONS �S -Q��GB
�(We) _ � -��� -/�+---� � � ��-�-�� certify that on the 1st day of
arch, 19��, I, (We) o pied a ur principal place of resi nce the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �I owned aG- �� �� �� -c�iGG� ��
�O are buying under contract
❑ have a beneficial ,jr�terest in the taxpayer
Property Description
Taxing District_(.Gity-�e++�n„ Township): /'/���
Parcel Number _
If buying on contract: Owners name ��� simo�e
, Y✓/_�u �..li- .. � . .
I .'
or legal description shown on tax statement:
�'T. /!/� % � �-/a2 . ��C/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 T.ownship
�hereby certify the above statement is true, correct and complete.
��,�.t. �- , �i,�ax,�o9,� a��o��_�� ��
ture Street Aaareu Ciry. tata an�
' 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 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land � � � � �
Residential Improvements � Dwellin���
JUNtiL1979
Garage
�� �� Total
Other Improvements� � ��""��d�Coit�
Tr• Improvements - Line (6) pI��QS�uals (8)
I,�.�iy certify th� above is true. correct. and complete.
Sign .ur oi Ass¢SSOr
.`
Approved:—
True Cash
Value
(�) y3—o
(2) — ° —
(3) � � 0
0
(4) �
cs) � 6 �--o
(g) s'� 5�0
��� _ o —
(s) � 5 g 5 O
- ACTION BY AUDITOR -
Assessed
Valuation
� �o
� ��
Homestead
Valuation
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: I
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� - � �— 7 /
Da:e _
Date:�z !�'�`l'