Homestead_McCloudI�i FOR NC���STEI�J Pf�O°�tlY TAX CRrDI7 FOR 'ftfiP �9g�
��yLd��' ScE BACK FOR FILltd6 1P;S7RUCTIO�JS
Z, '-.,.a�) 1� �Q.u.-.... � 0// �(�rt�.L �tifY tha*_ on t}ie 1st da;
�+3rch, 19 Q, , -��i� � our princi.Dal olace or residen� t}:e fol].a�ing desQib�d ry
Q�
p�rty ior �•%nich a il�r�stea8 �op�'sty Tax �edit is herelr� bA.ing claured:
Z, (i9e) �i a.t-n�-si
� are biry+inq urries contract
� haw_ a b�.n=ficial interest,in the t�ax-�yer
Proc_rty D_scription. in /�/ Gv�i�, ����
Ta.inq_ District ICity, To�m, �`ip� 7.�_.
�s�
0� 7� pp 7��-oa
'Ib.,rs
��r.�l tiL,-�ic��s or legal des¢iption sho'w'n on tax statQ�.st:
�j�'/�. %)� /� �,z-�-lo �f—
I= bu.•ina en wnLLact: Oc•m_ss n�re (fe° sirr�le o��m:s)
- - Con�ract rE.:ords3 in P�corder's Ofii� - I��cord tl�. Pag=
Z` an}' �or�ion of the residential stn:cture or the land, not a��e�ing or.e (1) acre that
i,-rm-=dia�ely sun��s �iat s`ructure is us� tn produce inca�, d_scrib° the ws arrl oortien c
tne oro�sty utilized to pmduce irrorre
- ^ - - - i., ., e �—
pn:y' o�er cai:nties in o:hich indic�dual ocans or is bui�inq r��l proo�.st��: Cbun�� TII::I'.SIllD
T her�y c. -`�if}' the �bOVe stat�mnt is
�� (����, � �'�-�-�-� _
true, �rrect arri con�lete.
Q�- N-� %�tx 333 .�iu
ocr nrinraca .. . C1ty.
*Individu3l eith°r a�'ns or is bsying wzer a contract that provides he is � nay �,�i_
p���• ta,ties on t]i° residence, or has a ib.�eficial intesest in th° tar.oayer.
- FOR ASSESS(NZ�S USE ONLY -
Larrl no����� �� acre inu��cliately
surrour�i ng rocarents
°``�'°r �''� APR a 1986
To�i ��a
�� }
P�siderkx�l ro s
�'-`�°�lT04
Dw?ZZu1G
Garaae
True czsh
Va1L�
(1) .�oo
(2) < �.o 0
�3) / 7 00
(4)
(5)
Total (6) 3 //!oo
Qtn,s Ir •rilrovan�zts t7) / a G D
7'c � Ir�rwerpsits - Line (6) plus (7) eau3ls (B) (8) .3� S�zo
� I hece�}� c�rtify `,ne a�av°_ is tn:e, correct,
an3 �nc�lete.
Si�iatur° or Itissssor
- ACiIOW ?Y AUJITnR -
t�ssesss3 Sk7r.�s�:
Valuaticn Valuac
a
`% o o ����j%�/�
S7 a ��%���j//.i,
�� � ����% �����%�i %
��L�LL�� / ���// �
1o39n /0390
� o %j ///,/�%
lO $/ O 1//��//
ce
//! 1 Date: �T, l9�ce
i+^� �v�' : �11 /� ( /2-�...c.
