HomeMy WebLinkAboutHomestead_Odom (3)FOflM HC 10 1979
PiescrioeE By Slate Bw�O ol ias Cammissfonen
CLAIM FOR HOMESTEAD PROPERTY TAX CREUIT FOR YEAR 19 79
io Be FileO in Uu�licate
SEE B F R FILING INSTRUCTIONS /
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�(We) �� �u •�� 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
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �� County � Township
Taxing District (Cit� Town, Toavnship): ��� � n-�-�^-�-�-
Parcel Number ' � or legal description shown on tax statemenk
(�d. 5�-�i,� /3-3-�i .o�
If buying .on contract: Owners name
�tee simo�e owne�� W E S T 5 � DL 5 s i. �. � l, S s5.
y Contract recorded in Recorders Oftice - Record No. Page
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:
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�hereby certify the above statement is true, correct and complete.
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'Sianamrc $tteet AOdR55
County Township
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Giy. State and Zip Gode I' y��
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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 ihe taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash
, Value
Land not exceeding 1(one) acre, immed�y
surrounding residential i en � (�) 3 So
Other Land �� � (2)
Total Land '
.►UM 121979
Residential Improvements welling
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� otal
Other Improvements �
T��Improvements .- Line (6) plus (7) equals (8)
I,.,,,zby certify the above is true. correct. and complete.
SiqnaNre o1 Assrswr
Approved
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Assessed
Valuation
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Homestead
Valuation
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Date: /