HomeMy WebLinkAboutHomestead_Harmonwwa xc io isn
RescnEeE By Sfate BoarC af Tax Commissioners
To Be FileO in Duplicate
CLAIM FOR HOMESTEAD PROPEHTY TAX CREDIT FOR YEAR 19 �9
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��� �-�-- Q certify that on the 1st day of
arch, 19�, 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 �/� �D0�9� Q�
❑ are buying under contraci
❑ have a beneficial intereQs�t in the taxpayer
Property Description in N�-- County � Township
Taxing District (Sify—Town, iawriship): �� �
Parcel Number or legal description shown on tax statement:
,��-.ti C�C�P . � s
If buying on contract: Owners
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 certify the above statement is true, correct and complete.
n �
noaress
County Township
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ana Zio Coae
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
�th$� resi�nce� h� beneficial interest in the taxpayer. _
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- FOR ASSESSOR'S USE ONLY -
r�r,q�� � o ����
True Cash Assessed Homestead
/ Value Valuation Valuation
Land not exceeding 1(one)��ed ely ' —
surrounding residential improvem t� (�) ��� ..Z�o °Z8o
Other Land AUDITOR (2) ���������
Total Land
Residential Improvements
(3) ��
Dwelling �4) � ��� �"'
Garage �5� � �� 8d
Total (6� � °
Other Improvements
T�Improvements - Line (6) plus (7) equals (8)
I.._.Cby certify the above is true. correct. and complete.
Signamre ol Assezwr
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(8) �a
- ACTION BY AUDITOR -
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Approved: � � • �� Date: J'-3o- � /
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