HomeMy WebLinkAboutHomestead_Sollman (8)wwn xc io ie�s
HeuriEW By State BoarG ol Tae fqmmissioners
To & FileO in Wplica�e
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOH YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We � certify that on the 1st day of
arch, 19 I, (We) occupied as our principal place of resi nce the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) fid'owned �(/ � �� / ��i-��
�?�ere buying under contract ��_�3 �� ��d_�� C��/ _�a�
❑ have a beneficial intere t in the taxpayer �� /
Property Description in County \-.�`�� Township
Taxing District (6+Sy—TewvrrTnwnahiol� � t-�-o'�-,
Parcel Number I'NW. � I°/7 I i�� I" � I��� or legal description shown on tax statemenY.
f�� NGtJ�sL / 7— 5L—/ n /. /L %a.r�
If buying O!1 contract: Owners name ��� simD�e owner�
Contract recorded in Recorders Office - Record
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.
�/� �q /
f l n/ /l U A/i r� n� � _ —
County Township
Sveet Fatlress - ciry, State antl Zip CoCe
(�r�.F i m, � 9 7 9
Individu I 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 nol exceeding 1(one) acre immediately
surrounding residential improvements
T�otal Land � I Ij �1 �"
Residential Improvements Dwelling
,i!J`�' 1= i979 �,.._
Garage
� ����Total
Other Improvements � AUDITOR
To+-' 'mprovements - Line (6) plus (7) equals (8)
I'��tiTy the abov� is true. correct. and complete.
Signa:ure ot
Ap
True Cash
value
(�) � DO
(p) �4
(3) -� O
(4) e?S'(o SGo
�s� —
(6) .�5� 5� o
(�) y 7 D
�a��� 6i c
- ACTION BY AUDITOR -
Assessed
Valuation
� 70
�
S =� 5� —'
Date
Homestead
Valuation
�
Date:
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