HomeMy WebLinkAboutHomestead_ByrnFORM HC 10 1979 To Be Filed in Duplicate
Nescrilfed By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 71
C}� SEE BACK FOR FILING INSTRUCTIONS 016 — D0r(�g_�
RWe) 0`-e- �r f �^^ e—t 13 , �J certify that on the 1st day of
rch, 19--l", (We) occur principal place of sidence 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
r
Township
Taxing District (City, Town, Township): a
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name flee simple owner)
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.
Individual Vt4pr owns or is buying under a contract that provides he is to pay the property taxes
c� residence, or has a beneficial interest in the taxpayer.
a(/ R ASSESSOR'S USE ONLY -
MAY 31 1979
Land not exceedin (b acre immediately
surrounding residential Impro t
Other Land AOO�OR
Total Land
Residential Improvements Dwelling
Garage
Total
Other Improvements
T ' ' Improvements - Line (6) plus (7) equals (8)
I .. y certify the above is true. corWct. and complete.
Signature of Asse55or
APP
True Cash
Value
(1) la SO
(2) —0—
(3) 4��O
(4)
(5)
(6)
(7)
(8)
Assessed Homestead
Valuation Valuation
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9:A / — 17
-"ACTION BY AUDITOR -
roved: Date:2 &0 �l 7