Homestead_White (7),u ,„1L1N1Ji11 CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
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/(We) �_ �� certify that on the tst day of
iroh, 19 , I, (We) occu ' d as our principal place of residence the following described rea! property for
which a Home tead Property Tax Credit is hereby being claimed: '
I, (We) Il� owned
❑ are buying under contract
❑ have a beneficial inter� t i the taxpayer �C //-�a� 3a�-�/.39a- G� .
Property Description in County Township
Taxing District (City, Town, Township): �
Parcel Number or legal description shown on [ax statement
��i4 ,-��� �8 �-I I g.so��
If buying on contract Owners name "�� �""�"° °""",
Contract recorded in Recorders Office - Record No
e
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
sUucture is used to produce income, describe the use and partion of the properry utilized to produce income
Any other counties in which individual owns or is buying real property:
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�' hereby certi(y the above statement is true, correct and_complete.
(�
County Township
' Individual either owns or is buying under a contracl that provides he is to pay the properiy taxes
on the residence, or has a beneficial interest in the taxpayer.
���j,.n�,U,!�� - FOR ASSESSOR'S USE ONLY -
JUN 13 1989
Land ,r1b�t� c�eedin;c�J�ekLsacre immediately
surro(f'nding �es�r�l mprovements
Other Land
Total Land
Residential Improvemenis
D�velling
Garage
Total
Other Improvements
T�Improvemenis - Line (�l plus p) equals (8)
I� ��,aby certify the above is irue. correcL and complete.
S�ynawre o� assesso�
True Cash
Value
(1)
(2)
(3)
(4)
(5)
�s>
(�)
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Assessed
Valuation
oa:��
Homestead
Valuation
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Date: l5? _ ` � `�