HomeMy WebLinkAboutHomestead_HarperFORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
t CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTIONS Olt#_ o0yS3- 00
;We) ��at Y R � certify that on the 1st day of
rvlarchI 19-1—t I, (We) occupiEM as our princ al place of residenle the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
O have a beneficial interest in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name "" 51np1e owner)
my Township
or le at description 47 shown on tax statement:
e l� _ a� �.. Qc(�1_ . 92%z Oz Ye-6-4L& 1- G
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:
rs'
)ereby certify the above statement is true, correct and complete.
n if
County Township
O
ly/�30
`J
Z S. o
eet Addreu ..ity. Slate ana Zp
Individual either owns or i ing 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 Assessed Homestead
Value Vahtatinn Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land F I `� L D
`Total Land d{t�
Residential Improvements Dwelling
JUfd 2 1979 g
Garage
y jz4K� Total
Other_ Improveme� AUDITORDDIITOORRR
Tc' ; mprovements - Line (6) plus (7) equals (8)
6
1`by certify the above is trLA. correct. and c9(nplete.
Signature of Asseswr
(1)
(2)
(3)
(4)
so /,'O /Z o
■ate - ;iiiiaiiaiaia
(6)
(7) -t�l
(8) 3 /,0
- ACTION '8Y AUDITOR -
0
�73 -79
Date
Approved: �u��v�B�J Date: