Homestead_SteinmetzF9RM HC 10 1979 �
PreSCriGed By Sute BoarO of Taz Commiuioners
To Be FIeO in Wplicate
.�—
CLAIM FOR HOMESTEAO PAOPEATY TAX CREDIT FOR YEAR 19�����������
�.:
'SEE BACK FOR FILING INSTRUCTIONS �j
t
�(We) L���- T�� E,g <.�G�c -- - c.a.r�rtltecS�!#y that on the 1st day of .
rch, 19_�, I, (We) o cupied as our principal place of residence the followiry��described real.property for
ihich a Homestead Property Tax Credit is hereby being claimed: ' '
(We) CiYowned G�(c —�9'9- ��� -oo�i9a-��� � tS'("�fL
o' v-
❑ are buying under contract �h{� �
❑ have a beneficial interest in the taxpayer -
Property Description in County
Taxing District (City, Town, Township): �
Parcel Number
Township
or legal description shown on tax statement:
��� i - i �
�'�' �zi7�`1%'°�/9-3 /o ���
If buying on contract: Owners name �'� 5inip1e °w^ef�
����� Contract recorded in Recorders Office 9 Rec (r j No. Page
If sidential structure or the land, not exceedin one 1 acre that immediatel surrounds that
structure i used to produce income, describe the use and portion of the property �utilized to produce income
MAR �0 19d9 •
ich individual owns or is buying real property:
here6y certify the above statement is true, correct and complete.
County
0
Township
CtlY. Sta[e antl
��ns 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 -
Land not exceeding 1(one) acre immetliately
surrounding residential improvements
Other Land �
Total Land
Residential Improvements
Q
Dwelling
Garage
Total
(�)
(2)
(3)
(4)
(5)
(s)
True 'Cash
Value
Other Improvements - (�)
T Improvements - Line (6) plus (7) equals (8) (8)
I by certiTy ihe above is true. correct. and complete.
$igndW�E OI ASSC550�
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
Date
Date: ��,.� �9