HomeMy WebLinkAboutHomestead_WeistFORM HC 10 1979
PrewiGetl By Slate Bodtd al ia� Commissianers
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 79
To Be FileE in Duplica�e
J
SEE BACK FOR FILING INSTRUCTIONS D/9- a3/b3-ov
��Ne) ' ,� �-Jp-�A� certify that on the 1st day of
rch, 19��2_, I, e) 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) C�owned
❑ are buying under contract
❑ have a beneficial inte,r.e/st� in the taxpayer
Property Description in �CJ.-.11dtrw County �4.te-+E�- Township
Taxing District (City, Town, Township): �:"�t.t ix.ct-%tx� � IO
Parcel Number or legal descri�tion shown on tax statement:
--��. NE .� �- a -/ � , a ��
c o.J F.,�2a. ,d� r . (4 ..�7
If buying Ofl contract Owners name ��� simpie ownep
Contract recorded in Recorders Ofiice - 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
� hereby certify the above statement is true, correct and complete.
�, . �
, s�76T�
"'Si namre .SVeet Aaaress Cl�y. S�aie a iv �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 interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1�e)�acre�me$�el�
surrounding residentia p vem ts �
Other Land
Total Land MAY 3 ��9�9
Residential Improvements Dwelling
������,��arage
�
AUDITOR Total
Other Improvements
T^�-� Improvements - Line (6) plus (7) equals (8)
i�by certify [he above is true. correct. and complete.
OI f�55e5SOt
True Cash Assessed Homestead
Value Valuation Valuation
(�) �470
(2)
(3) �G70
(4)
(5)
(6)
(�)
($)
- ACTION BY AUDITOR -
890
Da�c
�
Approved: �• � . � -u--Q-o��i Date: � ��' /__ �