Homestead_Broshears (3)FORM HC 10 1979
Prescribed By State Board of Ta. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-7Y---
SEE BACK FOR FILING INSTRUCTIONS —"�yl
-� (We) rtify that on
;arch, 19�, I, (We) occupied as our principal pl ce of residence the following describgd
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the
Property Description i
Taxing District (City, Town, Township): ° ` \
Parcel Number or legal description shown on tax to
i/ 2
If buying on contract: Owners name Ilee simple ownerl
Contract recorded in Recorders Office - Record
To Be Filed in Duplicate
t'
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:
I,hereby certify the above statement is true, correct and complete.
County Township
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 -
Sigrwwre of Assessor
66
Assessed Homestead
Valuation Valuation
.D- Qo
'jr�ov
.6--If — / y
oa:e
Date: / _7
True Cash
Value
Land not exceeding t (one) acre immediately
(1) �ar0
surrounding residential improvements
Other Land j4
Total Land �IL� N�¢96
I L EI D
(3)
Residential Improvements Dwelling
JUI_ 3 1979
(4) 9 ��
Garage
(5) {0 90
Total
(6) �0 /90
Other Improvements AUDITOR
(7)
Total Improvements - Line (6) plus (7) equals (8)
(8)
Ie,by certify the Above is true, corpct, and complete.
Sigrwwre of Assessor
66
Assessed Homestead
Valuation Valuation
.D- Qo
'jr�ov
.6--If — / y
oa:e
Date: / _7