HomeMy WebLinkAboutHomestead_BrokawFOFM HC 70 1979
PresuiGeO By Sta;e 8aar0 a� ia. Commissianers
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 9
io Be filea in Ouplicate
SEE BACK FOR FILING INSTRUCTIONS D//�DO/���0
�(We) `��—, ��/z.-d- ��r.,'�-��rsr�r-�- �e nO-t� that on the 1st day of
arch, 19 79 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 .
❑ have a beneficial interest in the taxpayer
Property Description in �._.��w-ar�. County -7�..-�-e-.�- Township
Taxing District (�jiy,_Towa�ewrtship): ��-� �
Parcel Number or legal description shown on tax statement:
�-2ci %,-Qa.n� 336 P,f- , f 3 3� �z`,
If buying on contract: Owners name �'� "mp1e °wnef�
Contract recorded in Recorders Office - Record No
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.�,�..�- Qn.s�.-�s %c�0 S. �nlqcTF�s �
'$ignawre Svee� ACEress
County Township
� ntc �F . �'e�[ �f 76¢�
Gity. S�a:e ana Zi0 �e
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 -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � �j � �
Total Land F�'
Residential Improve ��ts ig�g
_�J:. �
Dwelling
(/[ /��titk-"�"`" `" Garage
�/,/� Total
Improveme� � pUDI70R
Improvements - Line (6) plus (7) equals (8)
''lcertify the above is true. correct. and complete
True Cash
Value
( � ) 7 �-o
(2)
(3) 7�0
(4) -1-B—�r-a
(5) /5300
(6) �
��� --
u �
- ACTION BY AUDITOR -
Assessed
Valuation
a �o
'f�%
�
-� .—�—
�-i c.�
Homestead
Valuation
�
7'}'� �/ 7 �/
Da:c
Date: GL,L?�