Homestead_Wright (7)FORM HC tU 1979
PrescribeG By Su;e BwrG ol ia� Commissioners
To Be FileO in Duplitate
CLAIM FOR HOMESTEAD PROPERTY TAX CRE01T FOR YEAR 19Z O' 9� �
� SEE BACK FOR FILING INSTRUCTIONS �Q �
� .
P�(We) ��. �- � ` `t" -� ' ' ° � certify that.on the 1st day of
vtarch, 19��, I, (We occupied as our pri pal 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
❑ have a beneficial i;t�rest_ in the taxpayer
Property Description i
Taxing District t6ity-�ewa-Township): /"/'��
Parcel Number
If buying on contract: Owners name ��ee s�mo�e
�G-/� 09- � ,�9�s�o�/
%i7iu')c 7 �-c.i1- Township
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o�r legal description shown on tax statement:
� t' i ; S� %� >"- � - I � �Y 9. 96 �-
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 certity the above statement is true, correct and complete.
County Township
//"'Sgramre � Stteet Atlaress ' Ci:y. S:afe ano Zip Cooe
f/ � �-/i��%%
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
� _ on the residence, or has a beneticial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � � � �
Total Land
Residential Improvements Dwelling
JIJ't 21 i979
Garage�
���_���ota,
Other Improvements qUDITOR
T/��',� Improvements - Line (6) plus (7) equals (8)
°i�I�py certify the above,js true. correct. and complete.
ASSPS50!
True Cash
Value
�i� � b o
(2) 1��
(3) ��
(4)�3aio
(5)
cs� a 3 aiv
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,8, 3 a �o
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
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Da:e
1
Date: �L%/'
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