HomeMy WebLinkAboutHomestead_Elpers (22)FONM HC 10 7979
ReSCriheE By Sute BoarE ol Taa Cammissioners
Ta Be FiIM in OuDliwie
CLAIM FOA HOMESTEAD PROPERTY TAX CAEDIT FOfl YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
��(We) •� � certify that on the 1st day of
arch, 19 I, (We) occupied as o principal place of residence the following described real property for �
which .a Homestead Property Tax Cre t is hereby being claimed: �
�� -�3 -o� �60- aoo.as9-o
I, (We) � owned �� � � �O ���_ Q�
❑ are buying under contract
❑ have a beneficial i er st in the taxpayer
,
Property Description in ,�
Taxing District fGity, Towrr Township):
Parcel Number
Ii buying on contract: Owners name �'� ""'o'e °'""ef�
Township
or legal description shown on tax statement:
Dr, GcJ � s'w �� 7 - � /d /a-�e-�
Contract recorded in Recorders Office - Record
e
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:
�hereby certify the above statement is true, correct and complete
County Township
` Individual either owns 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 immediately
surrounding residential improvem�en9ts •
Other Land � � � G�9 �
Total Land �8
Residential Improvemen�$�` � �979
(�C . `f'i /�`tit1GQittrti
AUDITOR
Other Improvements �
D�ing
Garage
Total
T�iprovements - Line (6) plus (7) equals (8)
I. oy certi the above is irue. correct. and complete.
Signature oi Asxssor
True Cash
Value
��� s� o
(2) `_
�3� �`D O
(a) /%, �Oo
(5) -_
(s) /%i �o�
(�)
�s> �� �o 0
- ACTION BY AUDITOR -
Assessed
Valuation
/70
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Date
Date:
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Homestead
Valuation
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