Homestead_Winternheimer?_�CL1utu ny .�w�.c. .�.�..,� .. . .
CLAI�� FOR HOP�SfEAD PROPERTY TAX CREDIT FOR YEAR 19 g�
SEE BACK FOR FILl G INSTRUCTI-O7NS : �5 =b1 ���
w' � (.t�.,-„ :�� dini.g K'oerti_fy that on the lst day of
I, `,.,�e)
ch, 19 . I, (�7e) occimia3 as rns orincinal place of zasiden� t]� io]luaing des¢ibed real
�t,�erty for which a H�neste�d °m�ertY Tax CYeciit is h�eby being claimedc
I, '�;�) ❑ ownsi , p6�G� C����j�
� are buyina under wntract G�� ��-0310 -�
� have _a besv�ficial interest in the tamayer
G , �G3 . co,mty . D� � "� � ZbwnsniF
PropertY Des�=ription. in ���
':.axing District (City. Twm, 'Ibwnsh�P) :
p=scel thmioer I or lec�dl nescriDtion sha�rn on tax statarr�t:
Cf �. � E��f� 3 6- z- i Z /. 9G 3
I_' buyino om m�tract: OFmers �n� (fee sixr�le owr.=r)
Contract recoxda3 in F�corder's Office - Recard t3�. Page
Z° any mrtion of the resiciential structure or the land, not �e�n4 one (1) acre that
im�ciiately s�vimds that stn�ctise is used � pxomice i.nca��e, des¢ibe the use az�d nortion of
tne property utilized to pxvduce i�rome
pny o`:r�s cotimties in which individual vans or is-buying real pxo�esty.
� h�Y certify the ahove stata�wszt is true,
wrrect and conrolete.
� � � 'IbC9PSY'L1D
nature �u�� ��-�-�--.. - City, State a� 2ip C�
*Individual either owns or is buying imer a contract that �es he is iv nay the
Dzvoerty tax�s on the zesidence, or has a benefieial intet�st in tse taxp3Yer•
- F(1R ASSESS()R`S USE ONLY -
Iarrl not exceedin9 1 tone) acre im�ediatelY
S�sxo�3ing resia�ntial iaaioverents
C'-�i�r Iand
Total Iand
P=sid�tial 7�0��
�- .
Garage
True Ca_.h
Valt�
(1) So 0
!2) / � o
(3) (o L O
(4)
(5)
�� (6) 3 �S3 0
!7) ISBc
Cti:=r Inroxvvaneats —
qt� . ' I�zov�rents - Line (6) Plus (7) e�uals !8) (8) 3 7 `� / �
Z hereny �°-rt�fl' the above is t=ue. ��, ar�ci carrolete.
PSSSSOS
�
- ACfION BY u.IIDITnR -
Date:
P.��ov�:
Assessa3 HanPStead
Valuation Valuation
/'70 /7�
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