HomeMy WebLinkAboutHomestead_Sprinkle (3). •. •,CLAIM,fOR HOMESTEAO PROPERTY TAX CREOIT FOR YEAR 19�/ /
- ' E BACK FO ILING INSTRUCTIONS ✓
� . . D//-OG1�o3- p�
�� (W � certify that on the tst day of
�ti. 19 I, e) occupied as our p'n place of residence the following described real property for
w...,,n a Homeste �operty Tax Credit is hereby being claimed: �
I, (We� owned ,
❑ are buying under ntract . . ,
� ❑ have a beneficial � re in the taxpayer ` �
Property Description in Co nty Township
: Taxing District (Cily, wn, Township):
Parcel Number " ;� or I gal escription own on tax tatement: �
���� ������.�
If buying on contract: Owners name �1Pe �"^o�e ow�en • o2y
-' �� Contraci recorded in Recorders Office - Record No. Page
Ii any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
slructure is used to produce income, describe the use and portion of the property utilized to produce inceme
Any olher counties in which individual owns or is buying real property: County Township
I here certify the above statement is true, correct and complete.
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� S -v - z ,�� z.�
�9�� . . . •• . . Stree� naaress . ' �C��y. Simc an. zip ��c
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' Individual either owns�o�iislbuyj g under a contract that provides he is to pay the property taxes
on the residence, or has a beneficiai interest in the laxpayer.
: NAY o� 19tS� FOR ASSESSOR'S USE ONLY -
�w,�1' 3�'�-s
AU�I I OR
.and not exceeding 1(one) acre immediately
�urrounding residential improvements
)ther Land �
�otal Land
tesidential Improvements
True Cash
• Value
(�)
. (2)
(3)
Dwelling �4�
Garage �.
Total
)ther Improvements
-otal I ovements - Line (6) plus (7) equals (8)
her��ertify the above is true, correct. and complete.
(5)
(6)
(�)
(81
'�p�umrt o� nssessar
^ � r ACT�N BY AUDITOR -
Assessed
Valuation
1>.ue
Homestead
Valuation
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Date: �---� --- —