Homestead_Stone (2)FOflM HC f0 1979 '
NeuribeU By State BwrE ol TaM Cammissioners
CLAIM FOR HOMESTEAD PROPEHTY TAX CREDIT FOfl YEAR 19Z
Ta & Filed in Duplica�e
SEE BACK FOR FILING INSTRUCTIONS DOS'0�7�'7
i
�(We) ' certify that on the 1st day of
arch, 19.��, I, (We ccu ed as our principal place of residence th following described real property for
which a Homestead Property Tax Credit is.hereby being claimed:
(We) ❑ owned ��'�O -�G �o�LYI- aQ�/c�T Do�i�
❑ are buying under contract
❑ have a beneficial intefest in the taxpayer
Property Description
Taxing District ($ity-i�wn, Township): �'1'�—cc�n
Parcel Number
If buying Ofl contract: Owners name (�� SimD�e owne�l
/ �-( q���-•-/ Township
1 n _ /_
or legal description shown on tax statement:
� /��i �t � lo —.3—/� %, /74.ci..
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:
�hereby certify the above statement is true, correct and complete.
�1 ! _ ._ iT� r, n � � .Q ! �. 7 i
County
a�Y.
Township
ena Zip Cope
Individual either owns or is buying under a contract that provides he is to pay the properiy taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash
Value
Land not 9xceeding 1(o� ac�e im�dia� �
surroundin residential i rovdfnent (�) � o�
Other Land (2) � � ��
Total Land '��� � 1979- (3) 7..J �D
Residential Improvement��
�
Other Improvements
/��/���? G'�—{�9w e I I i n g
�eQ�age
AUDITOF}otal
Improvements - Line (6) plus (7) equals (8)
bxcertify the above is true. correct, and complete.
Approved
(4) 'y� 7 D
�5, a3 �o
(6) 7 � �
�,� � a a
(8) % 3 � d
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
� 7d
�� Yb
�b /0 3
_S - i 8�_ � g
Dare }
�
oate: �A �7�