HomeMy WebLinkAboutHomestead_EdringtonFORM HC 10 1919
Nesarfbed By State Board at lax Commissioners
To Be oleo m Ofipliaate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 /q
r" ' /� certify that on the 1st day of
arch, 19__1_'Z 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 taxpayer
Property Description in n County - Township
Taxing District (City, Town, Township): L
Parcel Number Al
If buying on contract: Owners
or legal description
on tax statement:
PUENN
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.
® _
and zip
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 -
True Cash
Value
Land not exceeding 1 (one) acre i mediltely
surrounding residential improvements E 1630 (1) �Z / 4LO
Other Land !UN (2) —� —
� 1979
Total Land
Residential Improvements
t��lf /��/D
.r•
Total O,
Other Improvements
To,-' Improvements - Line (6) plus (7) equals (8)
I- *by certify the aboyT is true. correrh. and complete.
Sigmwre of Assessor
Approved: t� w ! ✓,�
(3)
(4)
(5)
(6)
(7)
(8)
Assessed Homestead
Valuation Valuation
Da:e
Date: y /