HomeMy WebLinkAboutHomestead_DavisFORM HC 10 1979 To Be Filed in Oupliule
Prescribed By Stale Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19,, `)
� EE BA OR FILING IN RUCTIONS t)03 _101003a -00
(We) a'U GO, certify that on the 1st day of
March, 19 , I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) W owned L1_12 -d ;7-
❑ are buying under contract
❑ have a beneficial intere, tt i�ayer
i
Property Description in County Township.
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name Ore simple owner)
or legal description shown on tax statement:
2t, 97.E % 7 - -02- 9 /, 75za'_ eo/
Contract recorded in Recorders Office - Record No
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
certify the above statement is true, correct and complete.
Street Address Cit,
and
GO
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
(im
(3)
at
surrounding resident
im
rove e It
rove ents
Other Land
(6)
(7)
Total Land
r1RAY 1811979
Residential Improvements Dwelling
al, 4� Garage
AUDITOR Total
Other Improvements
Improvements - Line (6) plus (7) equals (8)
I hereby certify th�above is true.. correct. and complete.
Signature of Assessor
True Cash
Value
(1) SO-o
(2)
(00
(3)
4699Q
(4)
c.385Z0
(s)
—a-
(6)
(7)
_ �-
(8)
fi�o
- ACTION BY AUDITOR -
Assessed
Valuation
�0 3a
/f °U
o
-10-
/-41' 90
Dare
Homestead
Valuation
m 8o
Approved:
X. Y. .,/1 ��I> � Date:
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