Homestead_Kramer (5)Hescnoe0 By Slale Boam ol Ia. Commissfoners � '
.• CLAIM FOR HOMESTEAU. PROPERTY TAX CREOIT FOR YEAR 19 �� �9����
,
SEE BACK FOR�FILING INSTRUCTIONS �
�� e1 certify that on the 1st day oi
N��. 19 I, (We) occupied as our principal plac i residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: �
I. (We) O owned p�Ca -�/-G�-��G- �O. �J � �S
❑ are buying under contract
❑ have a beneficial interest in the taxpayer � �
Property Description in County Township
Taxing District (City, Town, Township): �/l/1�1���
Parcel Number . or legal description shown on tax statement:
_�-� Yl�.�-`�y St,u-�)U 7-�-1(� 1A
��� ���
If buying Ofl contract:-,Owners name ��ee simo�e ownerl .
� c'' ,_ , •_.e�L-/'
Contract recorded in Recorders Office - Record No. Page
If any portio{��pi;tFie re'sidantial 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
>�1>.t.
.A� )'i'�,wrs '
e
Any other counties in which individual owns or is buying real property:
I hereby certif�/the above statemer}1 is true, correct and complete.
Sheet Aaereu
i : - .
County
Township
ana Zio Goae
Individual eiiher 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 -
and not exceeding 1(one) acre immediately
urrounding residential improvements
�ther Land
otal Land
esidential improvements
Dwelling
Garage
Total
ther Improvements
otal ovements - Line (6) plus (7) equals (8)
here_, :,erti(y the above is true. correct. and complete.
qnat�re ol Assessor
��
True Cash Assessed Homestead
Value Valuation Valuation
�t) S`oo //7� // 7t7
(2) — �
�3, 3 so d� i ��a
�4� 31900
(5) --
16) %`�a D /��30 /z63o
��� � l 00 3 %o �
,8, 3 00o soo�
- ACTION BY AUDITOR -
n.,�.•
Date: ��l � �? !
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