Homestead_CoutsPOEM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �'T 1---�
- - certify that on the 1st day of
March, 19 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) owned
are buying under contract
❑ have a beneficial interest in the er
Property Description in
Taxing District (City, Town, Township)
Township
Parcel Number I I I I I I or legal description shown ort'tax statement:
�3JJ � 4/ ,cam
Y
If buying on contract: Owners name liee simple owner) ( 2— It
Contract recorded in Recorders Office - Record No. Paoe
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.
`T /(a (ov
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 improvements
Other Land FILED
Total Land
True Cash Assessed
Value Valuation
(2)
(3)
Residential Improvements., 1979 Owellin (4)
.Ill`- 13 9
Garage (5)
Total (6)
Other Improvements (7)
AUDITOR
T ' Improvements - Line (6) plus (7) equals (8) (8)
1 !! oy certify the abA is true corrg9t. and complete.
Signature of Assessor
-190
Homestead
Valuation
.ZAo
- ACTION BY AUDITOR -
Date:
6Z -�