HomeMy WebLinkAboutHomestead_Harden (4)FO�M HC 10 1979 io Be Filee in Du0licate
PrewiGeE By State Board ol Ta� Commissfaners
CLAIM fOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1912
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��''�"'�-z� ;��`-t�°�— �� ����s— certify that on the tst day of
�arch, 19� I, (We) occ ied as our principal place of residence th ollowing described real property for
which a Ho estead Property Tax Credit is hereby being claimed:
I, (We) �[] owned
❑ are buying under contract
❑ have a beneficial int res�xpayer
Property Description in Coun
Taxing District (Eity,—�ewn, Township): �
D0� -oo ��y
�� Township
Parcel Number or legal description shown on tax statement:
�v�. �w ��s� 9- a —� o �/. s�i ,¢)
If buying Ofl contract: Owners name ��� stmoie ow�e�l
Contract recorded in Recorders Office - Record No. Page
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.
ii.�.�1�_ � �,ct�t�4_2� � J�l � � �.. f C�it.
5�gnature Stteet n,.�res�
County
Township
Gity. Sta:� ana Zio �e
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�cr�im�di� �
surrounding residential im e n
Other Land
Total Land JU�d 521979
Residentiai Improvements
/� Dwelling
�/f . �, � f�uu2�rage
� AUDITORTotal
Other Improvements
T���' �Improvements - Line (6) plus (7) equals (8)
I��y certify the �bove is true. correct. and complete.
Sigwmre o� Assezwr
Approved:
True Cash
Value
(�) /Sc.c�
(2) i o 0
(3) / �0 00
(a) / 9 870
(5) —
(s) / 9870
��� —�c
(g) / 99 io
ION BY AUDITOR -
Assessed
Valuation
5co
� Lo
— - �L
l.:J
Homestead
Valuation
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Date: