HomeMy WebLinkAboutHomestead_Weiss (5)FOflM HC 10 1979
PreuriDeE By State Board of Tax tommiuianers
To & FileO in Dupliwte
CLAIM FOR HOMESTEAD PROPERTY TAX CflEDIT FOfl YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS 0�'. OO$S� "��
�(We) �-�-�a-� ; ��• ��� certify that on the 1st day of
arch, 19�L, 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 inte�re{s�t �in� the taxpayer
Property Description in /`"�"`�-*�^ County � Township
Taxing District (G'itp; Town, Taiecpship): �
Parcel Number
If buying on contract: Owners name ��� simple o.�e,�
or legal description shown on tax statement:
J%� . � � — .5�
Contract recorded in Recorders Office - 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:
�hereby certify the above statement is true, correct and complete.
County Township
��ig�uNr€ 9reet Aaaress ' Ciry. State ana Zi0 �e
'� � 6 5/�' '
' 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 n
Other Land � � �J � �
a �,
Total Land
Residential .Improvements
Other Improvements
,iU�d � � 197�Dwelling
Gar ge
� i /�iu-�'-GJP'�av
� AUDITQR
Te� Improvements - Line (6) plus (7) equals (8)
I rl�eby certity the above is true. correct. and complete.
Si5f13�u!¢ Of ASSPSSOr
True Cash
Value
(�) 19io
(2) —
(s) / 9. o
c4� �-�r-n
�s� -�.a'°
Assessed
Valuation
� �o
� j-°7 D
rL�
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/�i..•%/r ,;;
Homestead
Valuation
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- ACTION BY AUDITOR -
S. �!-7y
Da:e
Date: � " �� � � �