Homestead_HarpenauFOIfM HC To Be FileO in DuD����e
R ' te BoarE ol Ta Commissioners �(�, „_ ��— 1 . '
� � � ����V ��
CLAIM FOA HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19��
SEE BACK FOR FILING INSTRUCTIONS _ �
,��
(We) -`'� - certify that on the 1st day of
naarch, 1 ,(We) occupied as our pri pal place of residence the following described real property for
- which a Homestead Property Tax Credit is ereby being claimed: �/�
I. (We) O owned %�/ ,Ig-13 ��VV��`��•���
❑ are buying under contract a<<� �
._�r. ❑ have a beneficial in rest in the taxpayer )
Property Description in ,�=� �� County L6�� Township
Taxing District (C„iLy-Tewn; Township): /./�
Parcel Number
If buying Ofl contract: Owners name ��re simoie owneq
�
or legal description shown on tax statement:
�T SEy�/ SE/�[ /3-3-// �vtGa.�
,�r NE' %� i 3 -3-/ / � � �'-0�-�,itc.0
—�� i,486a �-: � �-
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or t e n� exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describ�e [� �and portion of the property utilized to produce income
Any other counties in which individual own�r is bu�ng�al property: County Township
certify the above statement is true, correct and complete.
' 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 i mediat� �
surrounding residential improveme�s/N �
Other Land �J � �9�g
Total Land �
Residential Improvements Iling
qU��TOR a9e
Total
Other Improvements
�" ' 4nprovements - Line (6) plus (7) equals (8)
_, cby certify� above is true. correct. and complete'
SignaW�e ol AssessO�
Approved
True Cash
Value
(i) So 0
(2) _ / � �a.�!%
(s)�.1.��
c4) is �,2 0
(5) —
(6) /S3 � O
(�) 3 3 S�o
�s> / P G 7 a
r�i��:�/t���i�C�i:�
Assessed
Valuation
�
g89 O
l-G-
Date
Homestead
Valuation
Date: _,C_�� � �� P 79
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