HomeMy WebLinkAboutHomestead_Lee (9)FORM HC 10 1979
Preuri0e0 By State BoarO a� Tax Commissioners
To & FileE in WDiicare
CLAIM FOR HOMESTEAD PAOPEflTY TAX CREDIT FOR YEAR 19�'� �
SEE BACK FOR FILING INSTRUCTIONS � �(C�_ p�s'q3 � ��%
n
�(We) d, �-ul� ��� certify that on the 1st day of
.�arch, 19 7 I, (We) occupied as our principal place of residence the 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 i/r}/�e�rest in the taxpayer �
Property Description in �G � County ,/'��� • Township
Taxing District (City, invJn-Townsttipj: �/�� f�
Parcel Number or legal description shown on tax statement:
� ,., n ., . �
If buying on contract: Owners
Contract recorded in Recorders office - Record
If any portion ot 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 ihe 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
..� _� � .___ O O / L
County Township
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
Residential Improvements
JUN ?� : 'i979
Dwelling
Garage
� Total
Other Improvem��' " AUD�T�
T' Improvements - Line (6) plus (7) equals (8)
I�oy certify,the above is true. correct. and complete.
$ignatW2 OI A55¢550�
True Cash
Value
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(2) � `__
(3) / o S—O
(4) ��—O
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(s) � �0
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- ACTION BY AUDITOR -
Assessed
Valuation
3s-v
3 S"�t
Homestead
Valuation
3 S'o
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Approved: �1�E8-���� Date: � -,7 ?- � �