Homestead_CooperFOR1.1 HC 10 1979
Piesc,ioea By State Bwt l of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 Z?
QQ � )a -aq -Q7
W:We') %-1'
19-79�, I, (We) occupied
which a Homestead Property Tax
GG nTC Fn0 PIT IAIr] InfcT0l lr'TIONS
To Be Fileo in Duplicate
D /b- O0 al7- oa
% certify that on the 1st day of
the following described real property for
I, (We) Xowned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
0/ . , ,
Property Description in ti County eiJ Township
Taxing District (City, Town, Township):
Parcel Number or legal description sho n on tax statement:
If buying on contract: Owners name 'fee 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
certify the above statement is true, correct and complete.
KA
Street Address
City. State a9l Z,b Coae
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.
L�C�, S, S SSESSOR'S USE ONLY -
Land not exceeding 1 (f ale irq{nedizr
surrounding residential ro ,men {Li,s
Other Land
Total Land JUN 26 1979
D 'd t' I I t
es l en la mprovemen s welling
g e
all,
AUDITOkotal
Other Improvements
Tro ' Improvements - Line (6) plus (7) equals (8)
I dy certify the above is true. 99rrect. and c
Signature of Assessor
Appro
(4)
(5)
(6)
(7)
(8)
6�
Assessed Homestead
Valuation Valuation
3 �7oC
—,9-90
44-&-
- .2 / -%9
— — Date
FOR -
Date: �
True Cash
Value
(2)
—O-
(3)
// &V
es l en la mprovemen s welling
g e
all,
AUDITOkotal
Other Improvements
Tro ' Improvements - Line (6) plus (7) equals (8)
I dy certify the above is true. 99rrect. and c
Signature of Assessor
Appro
(4)
(5)
(6)
(7)
(8)
6�
Assessed Homestead
Valuation Valuation
3 �7oC
—,9-90
44-&-
- .2 / -%9
— — Date
FOR -
Date: �