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HomeMy WebLinkAboutHomestead_BurnsFORM HC 7D 1979 To Be Filed in Duplicate PreuriDed By State Board of Tax Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 o � n SEE BACK FOR FILING INSTRUCTIONS 0 /!0 ©/S /- r�y�;We) E �• Vcertify that on the 1st day of `rch, 19 O l., (we) occupied as our principal O ar_.e 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 int est in the taxpayer (�V1 Property Description in �` " County " Township Taxing District (City, Tewra-�ip): �0 Q • -� Parcel Number or legal descripti n shown on tax statement'. 1 1 � If buying on contract: Owners name tree simple owner) Ali 95 (o1 —3p —35-36 3, 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 certify the above statement is true, correct and complete. Street Address ury, rare anp up cane Ind' er s r buying under a contract that provides he is to pay the property taxes 14 1 ence, or has a beneficial interest in the taxpayer. APR 22 1980 - FOR ASSESSOR'S USE ONLY - la•True Cash Assessed r Value Valuation Land not exceeding (one) �(Trediately surrounding residential improvements (1) iv S O a v Other Land. (2) Total Land (3) Cv S- 0 Residential Improvements Dwelling Garage Total Other Improvements Total- Improvements - Line (6) plus (7) equals (8) 1 I_Pby certify the abgye is true. correct t. and complete. Signature of Assessor Approved (4) (5) (6) (7) (8) Daie Date: Homestead Valuation j0 - ;�_ a- - 8 0