HomeMy WebLinkAboutHomestead_CumminsFOFM HC 10 1979
Reun�e0 By $tate Boa�C ot ia. fqmmi55ioners
To Be Fil¢G in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19 ?L
SEE BACK FOR FILING INSTRUCTIONS
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�We) qp-kM �- ���-�-�� �M+�a/ certify that on the 1st day of
arch, 1���, I, ( e) oc pied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being daimed:
I, (We) � owned DO/ � �O ���
❑ are buying under contract (f/
❑ have a beneficial interest in the taxpayer . n
Property Description in � County �7'�-+�-a-- Township
Taxing District (City, Town, Township): �4�s-�e�, �'�t-u-o
Parcel Number or legal description shown on tax statement:
�� NE. _1�. �s� .�/-/-/o /. 3� ,�)
If buying on contract Owners name �'� ��mP1e owneq
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: ' County Township
�hereby certify the above statement is true, correct and complete.
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Suret naaress
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Gry. Sta�e ana Lo �oe
' 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���m diat�A_ �
surrountling residential impr m ���
Other Land
JUN 121979
Total Land
Residential Improvements �
�• � 9
AUDI7GQdRage
� Total
Other Improvements
T�} � Improvements - Line (6) plus (7) equals (8)
I�by certify ihe above is lrue. correct. and complete.
Signature p'J Assessor
True Cash
Value
(i) 900
(2) 330
�3� /d 3 0
(4) —cz411_Q
(5) —
(6) 020'710
(�� a3a
�s> a2.a9 �o
- ACTION BY AUDITOR -
Assessed
Valuation
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oare
Homestead
Valuation
pp ����,y p�n Date: ���%
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