HomeMy WebLinkAboutHomestead_YelchFORM MC 10 1979
Prescri�ed By S1aie Boam ot Tax Commissfoneu -
io Be FileE in Uuplicate
. CLAIM FOR HOMESTEAO PROPERTY TAX CREDIT FOR YEAR 19 i`�
SEE BACK FOR FILING INSTRUCTIONS
` � .� . � y a,,, .• — � (��`Vrc-,��!- rn
.�`lWe) ��-'�-' � �, �• � cerkfy that on the 1st day of
arch, 19 791, (We) occupied as our principal place of residence the fo lowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:.
I, (We) ❑ owned �Q� _Qaa�D
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �`�� County `� � Township
Taxing District (Get}��vwr,rTownship): ��+--
Parcel Number or legal description shown on tax statement:
��- . s'�Z �s e �i� �� - � - �� �ys- �o�)
If buying Ofl contract: Owners name ��� s�moie owneq
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: County Township
i hereby certify the above statement is true, correct and complete.
�: �oP,aoX i3�
�,�i. 3 �ti � �.v . 4 7 70
. na�ure Snret Atlaress Gry. S�aie ana Zio Coae
' 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.
tS. f
C ` r
- FOR ASSESSOR'S USE ONLY -
fL ,�'-� ��;
Land not exceeding 1(onej.�acr�e immediately
surrounding residential improvemenls 19]9
Other Land �%/ (���
��
Total Land
Residential Improvements AUDItpA Dwelling
Garage
Other improvemenls
T � � Improvements
I �y certify the
Sigramre oi nsseswr
Total
True Cash
Value
(�) SCo
(2) �'�'o
(3� �o 0
�a� /03 ro
(5) —
�6� / O 370
��� s—�c
Assessed
Valuation
�
_ i� �� �
=:�,�i-==�+
����j����
���%����y
.,. .
-.
. -.
Homestead
Valuation
r
Line cs� Pi�s c�� equals �s� �8j /� 9�0 �$ '%/'%%�//�j%%%%i
�ove is true. correct. and complete. �l�
�� ���� �—'. y��,� � 9
oa:
Approved: � / � Date: _ � � l%�
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