HomeMy WebLinkAboutHomestead_Cox (4)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19`L
SEE BACK FOR FIL-IN'G INSTRUCTIONS Q /�• - Q �ay3_ � �
a-, g4t,2`� "� certify that on the 1st day of
March, 19_z�_ I, (We) occupied as our principal lace 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 in es t in the taxpayer
Property Description in Count tyy Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown one tax statement:
If buying on contract: Owners name (lee simple owned
Contract recorded in Recorders Office - Record No. Page 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 a above statement is true, correct and complete.
7 71�d
�Sngnature f Street Address Clay. Stale and Zip Code
In r or is buying under a contract that provides he is to pay the property taxes
ion sI nce, or has a beneficial interest in the taxpayer.
.L - FOR ASSESSOR'S USE ONLY -
MAY 3 0 1979
Land not e4ee'erfal �iately
surroun ding ntil impNPATlAfPs
True Cash
Value
(1) 13 A'0
Other Land (2)
Total Land (3)
Residential Improvements Dwelling (4)
Gauge (5)
Total (6)
Other Improvements (7)
T ' 'Improvements Line (6) plus (7) equals (8) (8)
I —by certify the above is true. c I rect. and complet
Signature of Assessor
11 - ACTInKI RV At
_"—
Assessed
Valuation
_o-
Homestead
Valuation
i1 "0
Dale
Date: / �!