Homestead_Michel (5)�oae ne �u e;s w u i i a i cir.�
P�escuoec By Sa;e doam oi iaR Lonmissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�— �� ���'��
SEE BACK FOR FILING INSTRUCTIONS
I,�e) �✓• certify that on the tst day of
Ma,�h, 19 ,(We) occupied as our principal place of residence the following described real property for
v�nich a Homestead Property Tax Credit is hereby being ctaimed:
I. (We) T� ov✓ned q�p —�`1 �CO - y3G� - ���.%j1,3 -�c�S
❑ are buying under contract
❑ have a beneficial interest i�n �thpe� ta-x�payer
Property Description in �i'�County
Township
Taxing District (City, Town, Township): �-��e'*'
Parcel Number legal description shown on tax statement:
p,�. Sw Ib-3��o �{I.so�n�
If buying on contraci: Oevners name ��ee z��,o�e ow��:i
Contract recorded in Recorders Office - Record N
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
struciure 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
I�reby certify the above statement is true, correct and complete
0
Stree� AGaress
Individual either owns or is buying under a contract that provides he is to=pa�the property taxes
on the residence, or has a beneficial interest in the taxpayer. �.i9a9
1UN 2 �
- FOR ASSESSOR'S USE ONLY -
�S ,
� ��Up1T0�
True Cash A sessed Homestead
Value Valuation Valuation
Land noi exceeding 1(one) acre immediately
surrounding residential improvements
Oiher Land
Total Land
Residential Impro��ements
D��,�eliing
Garage
Total
Other improvements
Tot21/�rovements - Line (6) plus (7) equals (8)
I hereLy� certify the above is irue, correct, and complete.
Si9w:uw o� Assessor
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(�) .3500
(2) DO
cs� / 7 9 0 �
�a� ��aOD
cs� 3io�
�s> 3 / 3 0 0
(�) ���
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�, rl� Date: �O-°iQ-8%