HomeMy WebLinkAboutHomestead_LaswellFORM HC 10 1979 To Be Filed in Duplicate
Prewioed By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 'Z?
SEE BACK FOR FILING INSTRUCTIONS
l(We)
arch, 19—;L5?- 1, We) occupied as our eincipal place of residence the follo
which a Homestead Property Tax Credit is hereby being claimed:
1, (We) ❑ owned X -/i/9- 5 oa -eW'
❑ are. under contract
11 have a beneficial interest in the taxpayer
Property Description
Taxing District
Parcel Number
Town, Township):
If buying on contract: Owners
o03 - ooggt_ ao
certify that on the 1st day of
Ning described real property for
Township
or legal description shown on tax statement:
/o & JCE % 1-12 - F -;30a-el /
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:
e by ert the a e
statement is
true, correct and
complete.
'Signature
Street Address
County Township
& 4,'7666
City. State and Zip Cope ,
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 Fnj iii D Total Land L Residential Improve L Dwelling
JLL 21979 Garage
Total
Other Improvemertis'��/ A/ R
Tny 1 Improvements - Line (6) plus (i� equals (8)
1 y certify the above is true. co�rect. and complete.
II i 1
Sig,ature of Assessor
True Cash
Value
(2) 1710
1
(3)
(4)
(5)
(6)
(7)
Assessed Homestead
Valuation Valuation
/70
;� O
Date
Date:
0