HomeMy WebLinkAboutHomestead_NolcoxFORM�HC 10 1979
Rescribe0 By State 9oarG o� ia. Commissioners
io Be Filed in DuDlicaie
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 � 9
SEE BACK FOR FILING INSTRUCTIONS
o �
�(We) G�, ��� �`'• certify that on the 1st day of
March, 19 ��! I, (We) oc pied as our principal place of reside ce the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) �owned .
❑ are buying under contract
❑ have a beneficial in�tey��e"st� in the taxpayer
Property Description in J�'�-�"-'-`^ County
Taxing District (Ciiy T��•� Township): �
(� -d��1sy
Township
Parcel Number or legal description shown on tax statement:
�9� y.�
��._ NuJ ��� irl tc� ��st 36 - �-/�
If buying on contract: Owners name "� 5irtip1e °""ef�
Contract recorded in Recorders Office - Record No. Paae
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.
��asl�
noaress
County Township
Individual either owns or is buying under a contract that provides he is to pay ihe 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
ootal Land � � � � �
Residential Improvements Dwelling
�i:P� 2 ^ !3?9
Garage
/�� Total
Other Improvement��/ �
'�!m rovements - Lfii e (6) plus (�}���q�s (8)
� P
I�eby certify the above is true. correci, and complete.
Sig�u:ure ot As5¢SSOr
Approved
True Cash
Value
1�) �(o 0
(2) � .
(g� `fGo
(4)
�s�
(6)
(�)
' (0 3 `f o
G ;3 5�0
— �
Assessed
Valuation
�Zd�,�v.
�
��>c
Homestead
Valuation
(g) / � 3 �o f r`��
�
ACTION BY AUDITOR -
Da:e
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Date: �/