Homestead_Woods (10)FORM HC 10 1979 -
P�escriUeO By S�ate Board of Tax Cammissione�5
Ta Be File� in OuDlicate
CcAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �° ,�
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
O have a beneficial interest in the taxpayer
Property Description in �-�--L-�-� County ^_ �� Township
Taxing District (City, Town, Township): `'�1�i�_���
Parcel Number or legal description shown on tax statement:
�,_¢� . o�°u.-y .�3 e�.�.
If buying on contract: Owners name
pee simo�e awner� �� •� '� 3� / �
Contract recorded in Recorders Oifice - 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.
I �
�:
County Township
ano Zio Goae
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 imm diately
surrounding resid���
Other Land
Total Land t9S0
Residential Improvemen�a� ����""'"- Dwelling
�� `� Garage
AU01T9� Total
True Cash
Value
(�) �
(2) �
(3) � �
(4)
(5)
(6)
Other Improvements - (�)
To I Improvements - Line (6) plus (7) equals (8) (8)
I�;by certify the above is true. correct, and complete.
�
Signamre ot nssesmr
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_ . � :
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- ACTION BY AUDITOR -
Assessed Homesiead
Valuation Valuation
i �
oa,e
Date:
,S io-Ba