HomeMy WebLinkAboutHomestead_DoschFOflM HC 10 1979
PrescriDeO By State BoarE ol Tax Cammissioners
To & FiIN in DuDlicate
CLAIM FOR HOMESTEAD PROPERTY TAX CAEDIT FOA YEAR 19Z v
SEE BACK FOR FILING INSTRUCTIONS O��%- DO���'��
�(We) certify that on the 1st day of
March, 19 �' I, (We) occupied as our pri I place.of residence the following described real property for
which a Homestead Property Tax Credit is ereby being claimed:
I, (We) 11d owned
❑ are buying under contract
❑ have a beneticial inte est in the taxpayer � �L e
Property Description in a���- County ��� Township
Taxing District (City, 7swa-�owrtship): ��-;-�
Parcel Number
If buying on contract: Owners
pae simple owner�
or legal description shown on tax statement:
S S
K .� � 4-G %�, � Tl� �
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:
�hereby certify the above statement is true, correct and complete.
Sveet Aaaress
County Township
City. State and Zip CoOe
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneticial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential imp� e� nts � ��
Other Land
Total Land
Residential Improvements �iJ�.J 2;��?`� Dwelling
Gprage
�� -ft-�
� ^Tot�
Other Improvements AUDITOR
Tr• Improvements - Line (6) plus (7) equals (8)
I f�by certify the above is true. correct. and complete.
oi nsseswr
�
True Cash
Value
(�) /!� 7c
(2) _'
(3) / (r '7 G
( 4 ) �:-.d�--?F75+
�s) /S-y 90
(6) /�
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Assessed
Valuation
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Date:
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Homestead
Valuation
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