Homestead_White (18)FORM HC 10 1979
RescriEeE By Sute BoarE af Ta. Commiuianers
CLAIM fOR HOMESTEAU PROPERTY TAX CAEDIT FOA YEAR 19�2_
To & Filed in DuD���ate
J
or9 -�3�90- o0
�(We) � � .�a. � certify that on the 1st day of
vlarch, 19� I, (We) occupied as our principal place of r idence the following described real property for
which a Homestead Property Tax Credit is hereby bein cI�R GtJ/Lc�
I, (We) owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ,� County ��r�y Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name �'� ""'o'e °""ef�
or legal description shown on tax statement:
� •.u.. i �- �
Contract recorded in Recorders Office - Record
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
/ yi�- a
Any other counties in which individual owns or is buying real property: County
�hereby certify the above statement is true, correct and complete.
� b1..ti, d. �.
Township
. �� Y76��
ana 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 beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Ot�hal Land � � � � �
Residential Improvements Iling
JUN � 7 t��
Garage
� TolaJ
Other Improvements - � �
T^' Improvements - Line (6) plus 7) equals (8��DITOR
-I.�oy certify the above is true. correct. and complete.
True Cash
Value
(1) � 20
Assessed
Valuation
�o (__
Homestead
%%/%/%%/%%%/%%/
. : � jjj/�j�j�/
/!/jj���j��/ jjjjjj/�jj/
_, .
jjjj/�jjjjj j/�j�/
. � . .
' jj�jj�j�/
� . . jjjjjjjjjjj
�i.r� .�1,.._.d.c�il - — —
Signa:ure Assesmr
ACTION BY AUDITOR -
Dare
Date: �/ 'Z7"� 9