HomeMy WebLinkAboutHomestead_Culbertson (3)FORM MC 10 1979
Prescribed By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-Zf—
SEE BACK FOR FILING INSTRUCTIONS
To Be Filed in Duplicate
0/&- ova 1/9- ov
We) Y� V 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 Cre is hereby being c
I, (We) IS owned
❑ are buying under contract
❑ have a beneficial interest,in the taxpayer n ,
Property Description
Taxing District (City, Town, Township): v a
Parcel Number
If buying on contract: Owners name time simple
Township
or legal description sh&wn on tax statement:
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
'Signature Sheet Address
City. State and rp'CoE&
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
t True Cash
Value
Land not excefng 1 (one acreEimme lately
surrounding residential improvements (1) 9�0
Other Land jn 2 0 1979 (2)
Total Land (3)
Residential Im4v�'/mM6 s ( a)
Dwelling
AUDITOR Garage (5)
Total (6)
Other Improvements (7)
Tr• ®' Improvements- - Line (6) plus (7) equals (8) (s)
10.3y certify the above is tr )T. correct, and complete.
Signature of Assessor
IMIXOM9121
AUDITOR -
Assessed
Valuation
�D--O
_B1
,3"
Homestead
Valuation
1
Dale
Date: