Homestead_Dupps (3)FORM TIC 10 1979 To Be Filed in Duplicate
Prescribed By State Board al Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-M
SEE ,
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name uee simple
my
Township
or legal description shown on tax statement:
CICt-A i di-at 7a 4Z /&. LF /SJY2 ,
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 ind- Iv'ral owns or is buying real property: County
I hereby certify the above statement i(ue, correct and complete.
AN /1 / � (\ 1 \ I n -
Township
cnr. 5:ata,ana Zip �-e � 7lD C d
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
Other Land 11 L E D
Total Land
Residential Improvements '1114 1 1979
Dwelling
Garage
r AUDITOR Total
Other Improvements
A IA TVI I Improvements Line (6) plus (7) equals (8)
Dy certify the aboyt is true. correyt. and complete.
pt Assessor
(4)
(5)
(6)
(7)
(8)
Assessed
Valnatinn
�-540-
-D -
Homestead
Valuatinn
, _ ?a - Z9
- ACTION BY AUDITOR -
Date:
True Cash
Value,.}
(1)
g�QV
(2)
�-
(3)
nn-
(4)
(5)
(6)
(7)
(8)
Assessed
Valnatinn
�-540-
-D -
Homestead
Valuatinn
, _ ?a - Z9
- ACTION BY AUDITOR -
Date: