HomeMy WebLinkAboutHomestead_BaileyFORM HC 10 1979
Prescribed By Slate Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
A
0,
(We)
march, 19 I,
which a Homestead
3FF RACK FOR
Fit INC, INSTRIICTInNS
Property Tax Credit is hereby being claimed:
To Be Filed in Duplicate
Oo'5- 000VA -00
certify that on the 1st day of
following described real property for
I. (We) V owned �CO —� � 7� /UO �• Q/� Q�(o
❑ are buying under contract
❑ have .a beneficial inter t in the taxpayer
r
Property Description in A—) County Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name (' simple pwnen
or legal description shown on tax statement:
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: County Township
hereby certify the above statement is true, correct and complete.
Individual either owns or is buying under a contract that provides he is to pay the p
. on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash
Value
Land not exceeding 1 (one i
surrounding residential imp em nt (1) ��
Other Land (2) /3J-o
Total Land MAY 211979 (3) __L_'?
Residential Improvements (a) 12a-,/D welling
(L�4 (s)
r AUDITORTotal (6)
Other Improvements (7) LSD
T
Improvements.- Line (6) plus (7) equals (8) (8)
i4aby certify the above is true. correht. and complete.
Signature or ASWB f
FrOMM
M
Assessed Homestead
Valuation Valuation
S -/g -79
Date
Date: 5-6911 79