Homestead_Wright (24)FORM NC 10 1979
Pre5[n�e0 By State BWta of iar LammissioneR
To Be Fiiea in Du0licare
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19ZL �
SEE BACK FOR FILING INSTRUCTIONS D�q— O.33JQ—�O
S(We) C��u-'u'"�^— ���� � certify that on the 1st day of
�vlarch, 19�, I, (We) occupied as our principal place of residence e following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
+,- (We) l� owned
�ns��"� are buying under contract
❑ have a beneficial interest in the
a� ,
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name!'eP
G �c�T� Township
or legal description shown on tax statement:
�{.� Q-c�o�. � //ia..t/a. /� l0
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
Any other counties in which individual owns or is buying real property:
� hereby certify the above statement is true, correct and complete.
County Township
Na,uE ,t��ti�=
' Individual either owns or is buying under a contract that provides he is to pay the properiy taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceedin9 1(one) acre immediately
surrounding residential�r��s� �
Other Land
Total Land
Residential Improvements JUN 2 �� i579 Dwelling
Other Improvements
,�% �� (�u�Z�Garage
��� Total
� AUDITOR
True Cash
Va1ue
( � ) � �D"�
(2) — v �—
(3) / o-�o
(a) 7 0
(s) —
(6) ..i ,
(�)
T ' Improvements - Line (6) plus (7) equals (8) . (a)
I�by certify the above is�true� correct. and complete.
SignaWre ol Nssessor v �1
Assessed
Valuation
33 0
—D—
Homestead
Valuation
� �"� �-%%%O//'/�%%%
:' j�����/�
-i
Oam
Date: �z � 1 � f
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