HomeMy WebLinkAboutHomestead_HerrinFORA1 HC 10 1979
P�escri�e0 By State Boartl of ia. Cammissioners
To Be FileG in Duplicate
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT fOR YEAR 19� �/
SEE BACK FOR FILING INSTRUCTIONS Or9 � Or�� O' OO
�(We) �-+ certify that on the 1st day of
�arch, 19�, I, (We) c upied as our principal place f re ' ence the following described real property for
which a Homestead Pro ty Tax Credit is hereby being claimed:
(We) !a owned
❑ are buying under contract
❑ have a beneficial int2rest ir� the taxpayer
S�1 //
Property Description
Taxing District (City, �ewn-�owrtsbip�: C��
Parcel Number
If buying on contract: Owners name "� s""01e °""e`�
nty \ � �=��oJ Township
or lega�l des� iption shown on tax statement:
•,d.._d'. ��1�/, a s�/a 3-/�s.
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.
�'1 1 n I � _ ^ . . n :n �
County Township
Girv. State ana Z Cotle
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 irr�uve�ents� �
Other Land �
Total Land
�%�'"� �% p 1979
Residential Improvemenls
Other Improvements
�J
Dwelling
arage
� ' �����al
AUD17pR
Improvements - Line (6) plus (7) equals (8)
�y certify the above i� true. correct. and complete.
True Cash
Value
(�) �lo � �
(2) �
(s� /lc 5 D
c4� `�D
(5) 7/��=�-�
(6) _��
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l8) _��
ol Assesw� U
� ) - ACTION BY AUDITOR -
0
Assessed
Valuation
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Homesiead
Valuation
�o-o�a-79
Oa:e
Date: ---1 / �