Homestead_Statenvw m v.y�. e
he5Cn0ea By Slaie BoatO ol laF fAmmissfonGS . -
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
(� � BOs 8018`{-Bo
�(yye) v v�—
rch, 19 I, (We)
which a Home tead Pr<
I, (We) fd'owned
❑ are buying �
❑ have a bene
Property Description in
Taxing District (City, T
Parcel Number �
in
FILING I
�r
�� �c�—�i�y'�''C'�J�'-�J�(�{ify` h�Y on the 1st day ot
as our principal place of residence the tollowing described real property for
Credit is: hereby being claimed: � _ aol g`�
���"�'����� -,a,�, . 9�S
�in•�the taxpayer ' � �C.G �
Township):
If buying on contract: Owners
Township
�or le I description shown on tax, statement: .
�
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pee simo�e oaneq , � ' �.
Contract recorded in Recorders Of(ice - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that immediatety surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
� � �G _ /o -a� ,3a�-�Qa /e'S� Q�/
Any other counties in which individual owns or is buying real property: County Township
� . • ,
�� hereby certify the above statement is true, correct and complete.
/( U.t�. �'"'�; � h�Gv� �2 7 3� b 1
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'S�gwmre . . . . Streei AOaress . .
. . „ . . � . ' ' i . . . CJty. S�aie ana 2�p Code
. . . . .. . � . . � , , .. . � . . . . � . . .
��c�� .r��\
' Iniiividual either owns or is buying under a coniraci that provides he is to pay the property taxes �
���,�� fLon�.�the residence, or has a beneficial interest in the taxpayer.
! i
JU, J 2�y �p�r� � t - FOR ASSESSOR'S USE ONLY - 1�
i
0�,� � r.;.�.�-� . .
RUDtTOR
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Resideniial Improvements
True Cash
• Value
(�l
(2) .
(3)
Dwelling �4�
Garage �5�
Total �6�
Other Improvements
To'.�nprovements - Line (6) plus (7) equals (8)
I I�y certify the above is true. correct, and complete.
SigewWre oi Assessor
(�)
�
Assessed � Homestead
Valuation Valuation
Oalc
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