Homestead_WaldenFORM HC 70 1979
PreuriGeE By State Board o� Tax Commissioners
To & FileE in Duplicate
CLAIM FOR HOMESTEAD PflOPEflTY TAX CREOIT FOR YEAH 19 ��
SEE BACK FOR FILING INSTRUCTIONS
�(We) ��^^�, �`�-^�-�� certify that on the 1st day of
March, 19 8�' I, (We) occup d as our principal place of resid ce the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) L7 owned
❑ are buying under coniract
❑ have a beneficial inter�$t in the taxpayer
Property Description in p��`�°-"`� County
Taxing Oistrict (CiRy—�ewn, Township):
�D� � o aoi7
�
Township
Parcel Number or legal description shown on tax statement:
� w �� � E '�s� 'r'— z —ii i. �i 9 � �,
If buying on contract: Owners name �'� °'"'we °""ef�
Contract recorded in Recorders Office - Record No. Paoe
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:
;�ereby certify the above. statement is true, correct and complete
�
County ' Township
�
v � � eti,k... �
Ciry, State anC Zio �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 in[erest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceedin� ( e �e tely
surrounding residetr�f"fal ��em n s"'"
Other Land iv1N( � ��Q?
Total Land /� �
Residential Impro�trYkS•����'"
AUDITOR Dwelling
- Garage
Total
Other Improvements
l�;lmprovements - Line (6) plus (7) equals (8)
I hereby cerlify the above is true. correct. and complete.
Signatuee ol Assessoe
Ap
True Cash
Value
(1) So 0
(2) i o
(3) S/ o
(4) 02 i SSo
(5) —
�s� aisso
(�) —
�8� a i sso
Assessed
Valuation
/ 70
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/ o-Z o
Homestead
Valuation
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Da:e
Date: � y8^ o ��