Homestead_Edrington (2)FORM HC 10 1979
Prescribed By Slate Board or Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 -1q
SEE BACK FOR FILING INSTRUCTIONS
To Be Film in Duplicate,
0/6 -ID o3 /b -o0
®(We) certify that on the 1st day of
March, 19-' � I, (We) occupied as ou rinci I place of reside a the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
(We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
4f ! i I
Property Description
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name nee simple owner)
my LitiJ Township
or legal description shhow�n on tax statement:
ll �tGL. % E—eAJ ?-,
Contract recorded in Recorders Office - Record No
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 T wnshi
,`tereb erI y the abov tement true, correct and complete.
'Signature Street Address City. State and kro Coni,
/ Individual either own 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
Residential Improvement�':� T� EDGarage
Dwelling
iii? ,(+
Other Improvements
True Cash Assessed Homestead
Value Valuation Valuation
(1) /a 90
(2) —0—
(3) /.,290
30
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Date
Date: