HomeMy WebLinkAboutHomestead_Black (2)FORM HC 10 1979
Prescribed By State Board of tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 1?
SEE BACK FOR FILING INSTRUCTIONS Quo - 0 0 0 '1'7- C
�(We) 9;ii - L e, j certify that on the 1st day of
March, 19-Z7, I, (W4 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) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in
Taxing .District (City, Town, Township):
Parcel Number
If buying on contract: Owners name Ilee simple ownerl
Township
or legal description shown on tax statement:
Contract recorded in Recorders Office - Record No. Page
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.
Street Address C/ /. State and Zip Code
Individual ei er owns or is buying under a contract that provides he is to pay the property taxes
sidence, or has a beneficial interest in the taxpayer.
ASSESSOR'S USE ONLY -
Dun r,
i9,79
Land not exceeding ica mmediately
surrounding residenti lmpr v
Other Land AUDITOR
Total Land
Residential Improvements Dwelling
Garage
Total
Other Improvements
T, ®-'- Improvements
leby certify the
Signature of Assessor
Approved:
Line (6) plus (7) equals (8) (8)
)0e is true, correct. and complete.
Assessed Homestead
Valuation Valuation
-1 J
i
15-- If -a
Date
Date:/ /
True Cash
Value
(1)
16 v-0
(2)
-0-
(3)
/& D-o
(4)
(5)
o
(6)
(7)
- 7
Line (6) plus (7) equals (8) (8)
)0e is true, correct. and complete.
Assessed Homestead
Valuation Valuation
-1 J
i
15-- If -a
Date
Date:/ /