HomeMy WebLinkAboutHomestead_CesarFORM HC 10 1979
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192
To Be Filed in Duplicate
J
FOR FILING INSTRUCTIONS 003 v�oN3- 0Z
,(We)- 7p� -�-f th r- � certify that on the 1st day of
(March, 19�M Y (We) occupied as our prb1cipal 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
❑ have a beneficial inter st in the taxpayer
Property Description in— r County Township
A
Taxing District (City, Town, Township): (_:D
Parcel Number
If buying on contract: Owners name (fee simple owner)
or legal description shown on tax statement:
U-X . KL Jf %
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: County Township -
'-hereby certify the above statement is true, correct and complete.
•
nature Street'AdEress City. State and Zip Cone
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
Other Land
Total Land
Residential Improvements
Other Improvements
Tom'-' Improvements - Line
I
Tr,'-'
certify the above
Signature of Assessor
Approve
i
True Cash
Value
(1) 15-e-0
2) —o—
L E 3) �B O
UN Dw IIJ�999. (4) x'030
Garage (5) —o—
T ) 800
plus (7) eq als (8) AUDITOR (8)
true, correct. andpcomplete.
Assessed Homestead
Valuation Valuation
Date