HomeMy WebLinkAboutHomestead_SissonFORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 IF ✓ll
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■(We) -A- Z_ 0'� �—? s ertify that on the 1st day of
arch, 19�, I, (We) occupie as our principal pl a of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: p
I, (We) ❑ owned OIC� -1--3 -,::,W
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name (fee simple owner
Township
i
or legal description shown on tax statement: 3 q 11
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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(Q�certify the above statement is true, correct and complete. — nn
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'Signature Street Address City, State and Zip Code
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 -
F L E ® True Cash
Value
Land not exceeding 1 (one) acre'!gmediatl.ff
surrounding residential improvements
Other Land 421, (2)
Total Land ��'` �p °ti (3)
Residential Improvements AUDITOR (4) /aF.5z/0
Dwel)ing
Garage (5)
Total (6) - -c --� z -"
Other Improvements (7) _ 4-
To' Improvements - Line (6) plus (7) equals (8) (8)
I Qoy certify the Dove is true. co . rect. and complete.
Signature of Assessor �j n
Assessed Homestead
Valuation Valuation
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Dare
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'" - 'ACTION BY AUDITOR -
Approved: � Q. Date: 441 ' 16� - 7 g