HomeMy WebLinkAboutHomestead_ChamnessFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By Stale Board of Tax Commissioners /
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19� ✓
�% SEE BACK FOR FILING INSTRUCTIONS Dill - oD/'7;L
40 `� , � - — � OJ�+�u� certify that on the 1st day of
March, 19� I, (We) occupied of residence the following described real property for
which a����,,,FHomestead Property Tax Credit is hereby being claimed:
I, (We) owned
are buying under contract
❑ have a beneficial int rest in the taxpayer
Property Description in J p County Township
Taxing District (City, Town, Township): L/ f'
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name (lee 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
�-•l _hereby certify the above statement is true, correct and complete
Address
Township
City. S:ms ano Zip
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 t (one) acre immediately
surrounding residential improvements
Other Land L E
Total Land
Residential Improvements Dwelling
JUL 1979
Garage
Total
Other Improvements '
T 4 l- Improvements - L e (6) plus (A�eRi OR (8)
I �vy certify the above A true. correct. aid complete.
Signature of Assessor
Approve
True Cash
Value
(1) /oZZ�-o
(2) —0—
(3) /go--o
(4)
(5)
(6)
(7)
(8)
Assessed
Valuation
Homestead
Valuation
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_.-L, i- 79
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Date:— �'3/ -7�