Homestead_Schaefer (3)roxu nc iu is�v . . . , ..
Prtu�i�e0 By Slale BWrA ol ia+ LommissioneR /
�
.• CLAIM FOR HONIESTEAD PROPERTY TAX CREDIT FOR YEAR 19���7�m��� �
�.' SEE BACK FOR FILING INSTRUCTIONS ��
�Ne) • certi(y that on the lst day o(
ch, 19�, I, (We) occupied as our rincipal place of sidence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) �� �� ��-�7'•�1�-o�L�-
� -6��
Township
Parcel Number, or legal description shown on tax statement:
�� . Yl� �� �� � �Q �
If buying on contract: Owners n
7
_ Contract recorded in Recorders Oifice - Record Ni�. Page
If any portion of the residential 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
Any other counties in which individual owns or is buying real property:
reby certify the above statement is true, correct and complete.
County Township
�Q,�„40.� R � dio�l� �/ ?�.� %�z�—�- � Y? G
e !' . . . . , . . . Slreet AOdrezs �Y����
�
' individual either owns or is buying under a contract that provides he is to pay�t�F�o�E�T�tpxes
on the residence, or has a beneficial interest in the taxpa�n 70J
. � �� - FOR ASSESSOR'S USE ONLY - y��
. �AUDtTOR �^ s
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements Dwelling
Garage
Total
Improvements
Tc. ,��,provements - Line (6) plus p) equals (8)
I hereby certify the above is true, correct. and complete.
Si9naMe ol Assesm�
'�:
True Cash
Value
(�) d SO O
�2) .3��OC�
�s> 3?900
�a�
(5)
cs� Sa_� o0
��,
($)
� - ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
Il�o
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��1�30
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Dat�: -�_// ��--1 - ---