Homestead_Wagner� CLAIM fOR HOMESTEAU PROPERTY TAX CREDIT FOfl YEAR 19�i— Do5-a18�5-�
• . SEE BACK FOR FILING INSTRUCTIONS �
I, (We) "'��"^0 Q � �'a� "'• ""�~ certify that on the 1st day of
P h, 19� Wel occuoied as ou principal place oi residence the following described real property for
�� a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned . �(O -�/' /� �DO-�Q� ��.� ���
❑ are buying under contract
❑ have a beneficial interest in the taxpayer � ..1 ,.�n �
Property Description in �1� County 1� � Township
Taxing District (City, Town, Township): �� '
Parcel Number or legal description shown on tax statement:
Q.�.�l�a i�-3-�a S.agAc
If buying on contract: Owners name �'� "inp1e °""e"
Contract recorded in Recorders Office - Record No. � Page � �
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
siructure is used to produce income, describe the use and portion of the property utilized to produce income
Any olher cou�ties in which individual owns or is buying real property:
I hereby certify the above statement is true, correct and complete.
a
County Township
��' - � 09.�.-� `e Z C �o S
���-N—yp�/- ��U� � R 3 O� +'�'��
•Signalw0 I . , .. � � . . . S�t¢e� AOOte55 e . . . G Y Scaie ana Zip Coae
' Individual either owns or is buying under a contract lhat provides he is to pay th�YO�e �
on the residence, or has a beneficial interest in the taxpayer.
�b
. 989
e
�
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land ,
Total Land
Residential Improvements Dwelling
Garage
Total
1�1
(2)
(3)
(4)
(5)
(6)
True Cash
Value
Other improvements ���
To�mprovements - Line (6) plus (7) equals (8) ($)
I t �y certi(y the above is true, correct. and complete.
$igna�ure OI As5l550�
- ACTION BY AUDITOR -
Approved
�
MAY 0 21
%%.� �S
Asse se pUD 70RK�oR'es�ead
Valuation Valuation
Dair
/�j�/�/
Date: � °� �