HomeMy WebLinkAboutHomestead_BoxellFOflM HC 10 1979
Prescri�eC By State Bwrd ol 7a. Commissione¢
io Be Fil¢E in Ouplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19��
SEE BACK FOR FILING INSTRUCTIONS
�(We)� � certify that on the tst day of
��arch, 19�2 I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Q'owned D O� -b0/ p� -�
O are buying under contract .
❑ have a beneficial intere�s/t in the taxpayer ��/j
Property Description in �Ja�Je.nti County `��-c�-� Township
Taxing District (City, Town, Township): ��-� �.
Parcel Number - or legal description shown on tax statement:
_Pb�'JE � ''� .�/-/-/o• , ca� i4.
If buying on contract: Owners name ��� simple o.�e,i
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:
certify the above�sjatement is true, correct and complete.
2��
Sveec nooress
County
Township
�,.��1% ���7�
Giry. Sta�e aM Zip Cpoe
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 residenti�rnpgOVeme�ts � �
m
Other Land U f3 E�,
Total Land
True Cash
Value
(1) 2so
(2) —
(3) Zsa
Residential Improvements ����'1 %' `� ��•''� (a� 3� s�
� Dwelling
��d�'�"'" Garage �� —
�^.��2d�C�il�Total �� �s) 3 � sv
4
Other Improvements kUDITOR �q (�) J a
Tn�-' Improvements - Line (6) plus (7) equals (8) (a) 3 O
I��y certify the above is true. correct, and complete.
Assessed
Valuation
��
Homestead
Valuation
� �� b
�— �-F—'D5
Da:e
Date:
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