HomeMy WebLinkAboutHomestead_LythgoeFO�.•�iS � �. .
?rtzaf0e0 By S�ate Bazrtl ol Taa Commissioners
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CLAI�i'fOR
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�o Bc FICO �n o�nr�no
HOmESTEA�=-FROPERTY.;TAX CREDIT, FOR YEAA 19�_1_
FOR FILING INSTRUCTIONS �, _�py�OO
�. 1�I1Af����_�t�8'2. certi(y that on the 1st day o(
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MarcFi, 9 , I, (W�): occupied. as,our pnnclpal; �e:o resi5ience the following described real properry (or
�ahich a Homesiead Properry Tax �.Ccedit is hereby�.tieing` claimed: �� ._. -�''• ,; °�
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1, (4Ve) owned : _ . _ _` ' , :•' , -_ -. ` .._ . .- ..
• .,,; - .
❑ are buying under' contrac�', � �:". � :=-. :'. . .,
❑ have a beneficial interest in the taxpayer • "
Property Description;in°';� ' "'`�""��' ''=��' ' County' Township
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Taxing District (City, Town, Tov�nship): m�
P2rcel Number � or,legal descnpllon shown on tax statement_ ,.
��� I� �� . �'�« ,�=i �} � a r�,���.- � _ .
,� n t <<M�, -;� � ?b�'«�� � , . �-� �L�C.t Q.n�" 5:-5���� � I �_
If buying on. coniract: Owners name ��M simple owner�
FEB �3 1S�i�" Contract reQOFU�d in:Recorders Office - Record No. Page
It any� portion ` t�ie residential st{u�ture:'or the land, noi exceeding one (1) acre thai immediately surrounds that ;
struetG"r�=i�US 'tOZp�t�iC�Le.:�ncurn;.?nrd2sCribe,.ihe'use, and portion oi the property utilized to produce income "
Al3Ut! t¢ .
Any other counties in which individual owns or is buying real property
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`e� certi(y the. above siatement��is �.true, correct and complete.
AOOress
County Tov✓nship
Citv. S�a�c and Ln Caae
Individual either ovms or is buying under a contract that provides he is to pay ihe properry taxes
on ihe residence, or has a beheficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
ILand noi exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total ! and
Resideniial Improvements
P�hs�norovements
Dwelling
Garage
Total
(�)
(Z)
(3)
(4)
(5)
(6)
c��
True Cash
Value
� c.�ovemen+s - Line (6) plus (i) equals (8) (8)
I hereby certify the above is true. correct, and complete.
S�gnatum o1 Fsseswr
- ACTION BY AUDITOR -
Assessed
Vaivation
Daie
Homestead
Valualion
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- Date:_�' �^"