HomeMy WebLinkAboutHomestead_Brown (2)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tae Commissioners n
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING JNST UC 10 W,
C 1
(We) /+r certify that on the 1st day of
r arch, 19__1_?_ I, (We) 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)�Xowned p 1( oo 126-11, .
❑ are buying under contract
❑ have a beneficial inte st in the taxpayer
Property Description in ,County _ Township
Taxing 'District (City, Town, Township): </ w'
Parcel Number or legal description shoQh on tax statement:
Q c�...52 f •S��S S /s/�
If buying on contract: Owners name (Iae simple owner)
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 Townshi
Rt- MARiaN�LocYGtFQ
hereby certify the above statement is true, correct and complete. M iNrOjE. RIA,-d,
P I K F-- if A
D k� V . `I At�l,RtdcA cJ�y y7b66
ignature Street Address Cie . 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 -
Land not exceeding 1 (one) acre immediately
surrounding residential improvJJJED Other Land
Total Land
Residential Improvements 111N 111979
Dwelling
//�Jy�, G r ge
`" "� pUD170�otal
Other Improvements (�
True Cash
Value
(2) —0—
(3) :z VS-0
(4)
(5)
(6)
(7)
To"' 'Improvements - Line (6) plus (7) equals (6) (s)
l0-by certify thenbove is true. correct. and complete.
nI Asse..,
Assessed
Homestead
Valuation
Valuation
9A o,
8a o
- ACTION BY AUDITOR -
Date
Date: