Homestead_Owensa R�n t CLAIM FOR HOMESTEAD PROPERTY TAX
z� CREDIT/STANDARD DEDUCTION
,�` State Form Sa7s (R2 i ie2)
.�.
INSTRUCTIONS: See reverse side lor filing instructions.
. _. - . - ' - - - ' �""�:CERTIFlCATI
FORM YEAR
HC70
'e) J I I�/ (�f�/(�/�� cerlity th�pn tj��fa�oFaAalCFPi!
F—t�^—
,,Je) occupied as our principal place of esidence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract APR 0 8 1999
❑ Have a beneficial interest in the entiry that is liable for the property taxes on ihe property and thai owns the property or is bpyin�y nder a j�ontr�t.
If buying on contract, Pee Simple owner's name
Recorder's office where contract is recorded
County Township lazm
Parcel number A O�� Legal description �
ZJ I
If any portion of Ne residential structure or the land not ezceetling one (t) acre that immediatety
of the property utilized to produce income.
-/�,-��/o/- csao• 3��-�a�
4 � e Y�
Record number Page
town, township)
� /D //
t s cture is used to O��uce income, descnbe Ne use and portion
� � PROPERTY OWNED BY CLAIMAM IN OTHER COUNTIES � �
Caunry Township Counry Township
I hereby certity ihe above statements are true, correct and complete. Sg mre ot Caimam
bw�.� O
Address (number arMstreeC dry, sfate, ZlPcode)
(�. D . — � c.�C
� � ASSESSOR USE ONLY . � TflUE T ASSESSED HOMESTEAD NON-RESIDENTIAL
. � � - � VALUE VALUE VALUE � VALUE
Land not ezceeding 1(one) acre immediatety �
surtounding residential improvements. ��) - � G' � �
Otherland (2) ,
Total land (line 7 plus line Z� (3)
Dwelling (4) � , .
Residential improvements
Garage (5)
Other improvements (6) �
Total improvements (line a through line � (7)
Total value (line 3 p�s line 7� (g) '
I hereby certify the above is true, GorreCt, and Sgnature of Assessor Dare sgnetl
�,��nplete.
.tyirg action - Sgnamre of Auditor Date sgned
19_Pay19_
Lesser of ll2 Homestead
Valuation or $2,000
S
,-,_r1 ��_� .l_� i��.�i�� _ ` � �-f - Q ( � _� ^,