HomeMy WebLinkAboutHomestead_Bent (5)FOPM HC 10 1W9
Preuribe0 By State Boartl ot TaR Commissfoners
Ta Be Filea in Duplicate
CLAIM -fOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19 � 9
� (y�re) /��--.,�
�tarch, 19�i, I, (We)
which a Homestead Prc
SEE BACK FOR FILING INSTRUCTIONS
�• � certify that on the 1st day of
aQ�y r principal place of residence the following described real property for
Credit is hereby being claimed:
I, (We) ❑ owned �/�, �pD �.� D!�
O are buying under contract
❑ have a beneficial interest in the taxpayer �,/
Property Description in C-�-�-t� County -�'�'O�` Township
Taxing District (Eity, Town, TewasHiTr): �6'*--t �.-a.+`-e-�.-
Parcel Number or legal description shown on tax statement:
�-E /.t.J �/a. S � ��.�F I 3 - 3 - // . � S A
If buying on contract: Owners name �'re �'"'o1e °`°"ef�
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: County Township
; certify the above statement is true, correct and complete.
. Gv L 7` � h�% /� .�.e �',v
'Signawre Street aoaress City. Sta:e ano Zip Goae
4'> E fC�
' 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 ON�Y -
Land not exceeding 1(one) acre immediately
surrounding residential impr��t� � �
Other Land
Total Land
Residential Improvements ,��I' 1�3 79�9 Dwelling
�����u1� a��� e
AUDITOfY`°'
Other Improvements
T��,' Improvements - Line (6) plus (7) equals (8)
��aby certify the above is true. correct. and complete.
(�)
(2)
True Cash
Value
i .
Assessed
Valuation
3 0 �.
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Approved
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Homestead
Valuation
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Date: