Homestead_FergusonFORM HC 1D 1979
Prescribed By Blare Board of Tax Commissioners
To Be Filed in Duplicate I _
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 " c J
SEE BACK FOR FILING INSTRUCTIONS
We)� b certify that on the 1st day of
March,' 19 I, (We) occupied as our rincipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) .rte, owned
❑ are buying under contract
❑ have a beneficial interggt in the taxpayer
Property Description
Township
Taxing District (City, Town, Township): Parcel Number Number or legal description shown on tax statement:
"V. &�4a - &,� / 8 �
If buying on contract: Owners name (fee simple owner)
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:
hereby certify the above statement is true, correct and complete.
County Township
and
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 ne)[)acre �mmediftel
surrounding residentia Imp ctvem
Other Land
True Cash
Value_
(1) X90
(2)
Total Land JUN u ^ 1979. (3) —49-0—
Assessed Homestead
Valuation Valuation
Dare
Date: Zz Z72