HomeMy WebLinkAboutHomestead_Gentry (7)iORM HC 10 1979
RescriOeE By Srote BoarE of Ta. Commiuioners
To & FileO in Wplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CAEDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS 4/` DD�` OO
Q�� _g.- �Q,C7�1.e�...:...77�s..c...�' �''`j'"�"`-,�`.;� oa-�.s �oat.��
� We) �--�^"M^ �`u �1� t��� ��'-��-e- certify that on'the tst day of
,��rch, 19�, I, e) 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) H owned
❑ are buying under contract
❑ have a beneficial interpe'st i'n the taxpayer
Property Description in �-�^-�-� County ��T Township
Taxing District,.4Gi4y, Towrr, �aW�Fip): �� • �
Parcel Number or legal description shown on tax statemerit:
p�� ��. �
If buying on contract: Owners name �'���mweowner) �T � S� 13-3-ri • 0�4-�..
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds ihat
structure is used to produce income, describe ihe 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.
�S /%-t
Street naareu
County Township
City. State ana Zip CoGe
' 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(onel a e m��
surrounding residential ir'�v�me ts
Other Land ��
Total �and ,�N � 1 ��g�g
Residential Improvements
elling
��� rage
AUDITOR Total
Other Improvements
TM ' Improvements - Line (6) plus (7) equals (8)
I��by certify the above is true. correct. and complete.
:
� , _ , .
Signamre oi nssezsor
Approved
True Cash
Value
(�) �30
(2)
�s> � 30
(a) '9 ��a-
�s� /035�
(6) _ .e�
(�)
(8) �.�.�3'
�s o so
n j- ACTION BY AUDITOR -
Assessed
Valuation
.
r
-.
����������
�� i��G.///>„/�
//::'�%//l//�4ii �..,
�: o
o..
Homestead
Valuation_
�2 S o
0
��— �������������
a3o
�a-«-a/i /9� (
Daie �
Date: �� ` �