HomeMy WebLinkAboutHomestead_HathawayFORM HC 10 1979
PresaiEM By State Board ni Ta. Commissioners
To & FileC in WD��ea[e
CLAIM FOR HOMESTEAD PROPERTY TAX CHEDIT fOR YEAR 19 �9
SEE BACK FOR FILING INSTRUCTIONS
�(We) �Q�- ti U-�-O�� certify that on the 1st day of
eiarch, 19_?2, I, (We) occ ed as our principal place of residence the tollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)�owned
❑ are buying under contract
❑ have a beneficial int,QrQst in the taxpayer
Property Description
Taxing District (C}�y--Tawn, Township): �-/�
Parcel Number
If buying Ofl contract: Owners name ��� sim0�e owner)
dOlv-0D8t�
�"�'-r"-"'' Township
or legal description shown on tax statement:3, 3`ij AC.
�, S'GCJ ��s� 33 - � = / o �7
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.
�"
X
County Township
' 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 resideniial improvements
Other Land � � � � �
Total Land
Residential Improvements �
.i�'�J 2 c i9,� Dwelling
Garage
I -
Other Improvemen[s � �
AUDITp R
To ' Improvements - Line (6 plus (7) equals (81
I�oy certify the above is true. correct, and complete.
Signarore of
Approved
True Cash
Value
(�) ��o
�2> � vo
c3) � 9 �
�a� � /- 30
(5) �
(g� � / � O
(7) 780
�g� 39io
- ACTION BY AUDITOR -
Assessed
Valuation
i7o
�_�a.3'rr
�a��dd
Homestead
Valuation
i �o
a ��
G-s -�9
Date
Date: