HomeMy WebLinkAboutHomestead_HarknessFORM HC 10 1979 To Be Film in Duplicate
Rewnbed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR lg 79-
n SEE BACK FOR FILING INSTRUCTIONS 016 - 0O yY -? - -0a
I (We) -P'✓, 9 — /� 7�'� o- certify that on the 1st day of
arch, 19 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
Ar are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
Township
or legal description shown on tax statement:
,e=A. deu./ ". 4t(04149
If buying on contract: Owners name (tee simple owner)
Contract recorded in Recorders Office - Record No. Page 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:
certify the above statement is true, correct and complete.
WA
Street
County Township
city.
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 ( ) a�e ir[Pedia '
surrounding residential ro4men�
Other Land
Tnfal I and ti R 1979
True Cash
Value
(1) So a
(2) —O-
(3) �67O-D
AGI IUN BY AUUI IUH -
Approved: AV.
5
Assessed Homestead
Valuation Valuation
17
Date
Date: t'12 ^' '/'Y-/g