HomeMy WebLinkAboutHomestead_RobertsFORM HC 10 1979
PrewnOea By Stare Bwrtl ot Ta. Cammissioners
7o Be Filea in DuO�icate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 � 9
SEE BACK FOR FILING INSTRUCTIONS
�(We) %�-d-�-u � a�-�-Q-t-�� � certify that on the 1st day ot
�narch, 79�, I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned D(1 �- D I b90
❑ are buying under contract �
❑ have a beneficial intenr,�est in the taxpayer
Property Description in �1-�-�-.Y�% /� County �Q�-�-� Township
Taxing District (GiF�r;-�ewr,rTownship): `�a-�-'h-�
Parcel Number or legal description shown on tax statement:
�7" �i/� ��i' / G-� - ii �. a S� l
If buying on contract: Owners name
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 incoine, 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.
T > � n
Sneet Aaaress
County Township
Ciiy. S�ate anvZiv �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 -
� � True Cash Assessed
QValue Valuation
Land not exceeding 1(one) acre�mme�diatel
surrounding residential improvements (�) Sco /7v
o�
Other Land sliI`� L 6 1`' � (2) /—�0 3° --fa ��
Total Land (3) �� �'`° ��
Residential Improvements �% ���t� �a) /� a �_o_
(/� �
� Ga��flITOR �5�
Total (6� 3=� ���
Other Improvements
T�'�' Improvements - Line (6) plus (7) equals (8)
I�by certi(y the above is true. correct. and complete.
Signature o�
I//
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- ACTION BY AUDITOR -
%'O
Homestead
Valuation
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o y !� o
lo� �/�y
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Date: —(O�f (O — ��