HomeMy WebLinkAboutHomestead_Hardiman (10)FORM HC 10 79i9
PrescriEeG By State Baard ot Ta. Commissioners
io Be Pilea in WDlicate
CLAIM FOR NOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS
�(We) !�-�' ��- 1�OS �-u-^-� rtify that on the tst day of
�iarch, 19_�_`�, I, (We) occupied as ou� pJ incipal place of esidence the f ing described real property for
which a Homestead Property Tax CrB�k�fs hereby being claimed:
I, (We) ❑ owned 0UV' �b �7�
❑ are buying under contract
❑ have a beneficial interest in the taxpayer 1 /
Property Description in �-�—�-�-�+^ County �°�'�^-' Township
Taxing District (C����. Township):��� "
Parcel Number or iegal description shown on tax statement:
��f. �G'% .UE �% 7- z -.��. ���
If buying on contract: Owners name �'� "inp1e °'""e`�
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.
�,nnni,,�� �Y�I�ir�^> l� � .3 /�... � Y h/. �.
9gnaWre �� Sneet AOaress
County Township
a`a Zio
' 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 residential improvements
T�otal Land � � � � �
Residential Improvements � ,
, � � L ., i979
True Cash
Value
(�) Sc o
(2) / � �
(3) � � °
Dwelling (4) Sa o 0
Garage
� l����u,�� Total
<�
Other Improvements � AUDITOR
To' ' Improvements - Line (6) plus (7) equals (8)
I,�by certify the above is true. correct. and complete.
._ � , —
Signawre ol Assezsor
Approved
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Date: � /