HomeMy WebLinkAboutHomestead_Dunn (12)FORM HL 10 1979
Prewi�eG By S�ate BwrO ot ia. Commissioners
io Be fileE in Duplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��-�-�-<-a-� F-�-�p�%- ���- �- ��� certify that on 'the 1st day of
March, 19�X, I, (We) occupie as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being daimed:
I, (We) C3'owned � �� ' y`D����
❑ are buying under contract �J
❑ have a beneficial interest in the taxpayer
Property Description in � County ���r-� Township
Taxing District (City, Town, Township): ��� �
-ParcelNumber or legal description shown on.tax statement:_ __ _
Pt N E��y� -� Io -�-// �l. oS
If buying on contract: Owners name �'�` ""'°1e °""ef�
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.
X�.� � 7� �� J � ��` /, -��
'S�gnature Sheet Aadress
County
Township
State ana
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneTicial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land � �
Residential Improvements �
JU� '_ 7 1979
S."• �
Garage
Total
Other Improvements
F-' ' Improvements - Li� plus (7) egu'' s�
I�aby certify the above is true. correCY'�a�r��omplete.
sigeuw,e
True Cash
Value
(1) So 0
(2) R 7 0
(3) / j�9 0
(4) %ZOO
(5) —
(6) %aoo
��1 —L7 O
�s) �9Sd
- ACTION BY AUDITOR -
Assessed Homestead
Valuation . Valuation
���'
-�k�o �3a
/ 70
S •.3/-77
��� -- -
Approved: „�'�_—� �,C�%�oa ,�� Date:�;��9