HomeMy WebLinkAboutHomestead_ShoultzFORM HC 10 1979
Resc�i�eC By Sta�e Boam ot ia. Commissioners
To & FileG in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 ��
IONS
�(We) �`� %� � G� �'�'�""°'�""�" certify that on the 1st day of
vlarch, 19 �� I, (We) occ ied as our principal place of residence th 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 interest in the taxpayer
Property Description in �
Taxing District (GiFy-�e��Township):
Parcel Number
If buying on contract: Owners name ��� simo�e ow�e,�
Ob(� • 0/76�
��°��- Township
or legal description shown on tax statement:
o`l LCJ � /.f a 8 — � — / o (�iA�
Contract recorded in Recorders Office - Record No. Page
Ii any portion of the residential structure or the land, not exceeding one (7) 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, correci and complete
naareu
County
Township
ana Zi0 �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) acre immediately
surrounding residential improvements
Other Land
Total Land � � �
k�
Residential Improvements
�
Dwelling
�l;f�� 2Gai�j�e9
True Cash
Value
(1) �GG
� � �
i,i — °
_�
(s) —
o I (6) /73Go
Other Improvements � ���1��� (�) 3� 3 c
T�' ' Improvements - Line (6) plus p) uals (8) qUDfTOR (8) �� 99�
!�by certify the above is true. correct. and complete.
Assessed
Valuation
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Homestead
Valuation
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Date: �- �-� -% �'f