HomeMy WebLinkAboutHomestead_BloughFORM HC 10 1979
Rescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR
SEE BACK FOR FILING INSTRUCTIONS O/L 00 0 gFj- Qp
(We) e • y that on the 1st day of
arch, 19_�M I, e) occupied as our principal place of reddence the folio wi g described real property for
which a Homestead Property Tax Credit is hereby being claimed: C(' 10 %.�_I q 9
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
Taxing District (City, Town, Township): Ua
Parcel Number
If buying on contract: Owners
owner)
(Z ,r l 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.
r
ignature f Street Address City, State an L 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 FILED
Residential Improvements
JUN 2'9 1979
Other Improvements I/ AUDITOR
True Cash
Value
(1) a d-o -o
(2) '_p
(3) 4 0-o-D
Dwelling (4)
Garage (s)
Total (6)
(7)
Tr' ' Improvements - Line (6) plus (7) equals (8) (8)
Voy certify the abq?e is true. corWct. and complete.
Assessed
Valuation
Homestead
Valuation
Signature on Assessor 4/ �
A n - ACTION BY AUDITOR -
Vi=a / -7
Dane
Date: