Homestead_Tuley,rES..reo �� N !' ,+'� ' YEAR
�-'� , CLAIM FOR HOMESTEAD PROPERTY TAX FORnA"°
�_�p4�: CREDIT/STANDARD DEDUCTION p^� HC`ib
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6 INSTRUCTIONS: See reverse side lor �ling instructions. � � �/ �
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CERTIFICATION STATEMENT � � � ' ' " ' "�""' `"' '
I(We) certiy ihat on the 1 st day of March, 79_
I(We) occupied as our principal place of residence the fol ing descnbed real property for which a Homesiead Property Tau Credit is hereby ctaimed:
❑ I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in [he entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
� CONTRACTRECORDED �
II buying on conVact, Fee Simple ownefs name
Recorders office where contract is recorded � Recortl number . Page
PROPERTY DESCRIPTION �
Township Taxin dist" d town,t shipJ �
Parcel number Legal description
� �
�1 any portion of the resitlenlial structure or �he land not exceetling one (1) acre that immediately sunounds Ihat structure is used to protluce income, describe the uu and ponion of
ihe property utilizetl ro produce income. -
/�6�'- o3ao- �Q/. 903- a�--/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Caunry Township , CAUnty Township
Signature ol claimant
_reby certify the above statements are true, wrrec[ and complete. � �
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Address (number ana streel, ciry, state, ZIP cotle�
�i"l�. 1- 3ox ,�3a owc.asvrll� �..� �(obl'
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE . VALUE VALUE VALUE
Land not exceeding 1(oneJ acre immediately (� �
sunounding residential improvements.
Otherland (2) �
Total Iand �line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify [he above is Irue, correct, and S'9^at��e of /+ue�� Date signed
complete.
Veritying action - SignaWre of Auditor - Date signed
STANDARD DEDUCTION ALLOWANCE
i 19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or S2,000
Signature ot Auditor Date signetl