HomeMy WebLinkAboutHomestead_Weber (13)fOFM HC 10 19i9
Nesttibed By S�ate Bw�E al ia. Commissfoners
io Be Filee in Duplicate
CLAIM FOR HOMESTEAU PROPERTY TAX CREOIT FOR YEAR 192`� ✓
. SEE BACK FOR FILING INSTRUCTIONS O��- QO$y1-00
�(We) -�-L� ��O• 'f certify that on the 1st day of
�larch, 19_ %� I, (We) occ ied as our principal place of res ence 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 interestqi-n( the taxpayer
Property Description in /J.��+- ,�. County �� Township
Taxing District (C�+Fq Town, Township): -�'��' � �.-a�....�—G�
Parcel Number or legal description shown on tax statement:
/�e-�- . S'o�' `��
If buying on contract: Owners name ��� simpie owne.�
Contract recorded in Recorders Ofiice - Record No. Paae
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: County Township
� reby ertifY the� bovg statement is true, correct and complete.
� , l/1%�l.�' -�✓ `f' da�. ��.��" ��c.��
>r►cv�u ;�i �.�,f.�.s� 702 �. �o-eu.as� �. /�.�-�� �—�J
'Si amre 5[reei AOOress Gry. S�a;e and Zi0 Coae
' 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 the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
' Other Land � � � �9 �
Total Land g�
Residential Improvement�`14 � i97� Dwelling
Garage
� ��y��,� Total
[
Other Improvements (� AUDITOR
Tr'-' Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
Signamre o� assr%av
Approved
True Cash Assessed Homestead
Value Valuation Valuation
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