HomeMy WebLinkAboutHomestead_Siekman (9)WWI FOR HG -�S I EAD PMWERT f TAY, CP3I T FOR 'iUT B qO
SEE BACK FOR FILING INSTRUCTIONS
An by 0 l�M l Fi n certify that on the 1st day c ;
mo'rch, 1°C I, (Y1e) occupied as our principal place or residence the following described real ;
rn' for t:h ch. a Hoop- st�_ad Property Tax Credit is hereby being claixed:
'.
I awn, i 00 /.— 003`16
0 are btryinq u*der contract
have a b=aneficial interest in the taxpayer '
Property Description in County (n � 1oni:hi�
Ta'irng District (City, Town, Tommship): P z
)n, A rM
I
Parcel iiu-�rber I or legal description sly +m r. on tax statemst: 1
N,
14
i_ bLivLi c; on contract: V.wners rame (fee sinmle crr,Tler)
Contract record-a-1 in Recorder's Office - Record ib. Page
I air mrtion of the residential structure or the land, not e>:ceaii-ng one (1) acre that
i,inr.Iiately su=- ul-ds that structure is used to produce .i.ncone, describe the use aid cortion o:
rile DropeLy utilized to produce ircorre
?n:T' ocher counties is! which individual cFn or is buying real prop -rty: County Io�.Tlsluo
1 n�' ce_-Lify the above statorent is true, correct aril ecriplete.
b124 S24r�Z na lie street Frress City, State aid Zip Ccu:.
*Individual eithrar cFTns or is baying caner a contract ti-Lit. provides he is to pay the
uro=ty taxes on the residence, or has a beneficial intdrest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Ir1:•il P.Ot e.•'.Cee'. -Lng 1 (one) acre urredliately
surrouding residential it -DrovErpnts
Omar I.--rd
Total i Ind
p.esiO_ntial Inprove;rents D g
c•;ellin
Garace
Total
other lymra jement-S
(1)
(2)
(3)
(4)
(5)
(6)
(7)
True Cash
Value
Ire overru-Tts - tine (6) plus (7).eauals (a)
®eTy Cert =' the abOVe is tru °_, corTeCt, and cQRplet°_.
;1cilature Or FSsessor
- ACTIOH BY AUnt-rnR -
��Jsess`U Forest.: -..
Valuation Valuatic,2
(
ten J
YN
,
bate