Homestead_White (2)Wfl1A MC 10 1979
P�escribe0 By State Bwrtl of ia. Cammissioners
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19 7 9
` io Be FileO in Dualkate
SEE BACK FOR FILING INSTRUCTIONS oO5 �QiBq 3
��We� '��1 � ��� '—� � certify that on the 1st day of
��larch, 19� I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) � owned
� are buying under contract
O have a beneficial intgresj in the taxpayer
Property Description
Taxing District (Ciiy Tawa, Township): r��
Parcel Number
If bUylfl(J Ofl contract: Owners name ��ee simo�e ow�eq
ol(o //'c�/- n3Gb-�JD/. �93- Go�/
C�ty Township
or legal description shown on tax statement:
�Nwy s�� a�-3-�� ��
Contract recorded in Recorders Office - Record
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.
n
County Township
�lCl���v � �M
G�y. S�ate am Zip Coae ��G�
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 -
True Cash
p {� Value
Land not 9xceeding 1(onP)4�re�mme iatel� �
surroundin residential im r`�vem ts (�) S O O
Other Land �2�
Total �and JUfV = � �a79 —°
(3) �� O �
Assessed
Valuation
/7v
—o—
/70
Homestead
Valuation
..�•. ..•• '' ,�i_ .. %���%%���%% ���������
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- ACTION BY AUDITOR -
Approved: 11�
� _ /�! 7/n
Oa:e
Date: ___�/�[! � / `�
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