Homestead_HeacockFORM HC 10 1979
prescribed By state Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 gif
y / nSEE BACK FOR FILING INSTRUCTIONS
, (We)
March, 19 Sr I, (We) occupied as our principal place f resi f
which a Homestead Property Tax Credit is hereby being claimed:
To Be Filed in Duplicate
0/6 - ooy48 -o�
certify that on the 1st day of
the following described real property for
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in —County Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name ltee simple
or legal description shown cn tax statement:
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:
hereby certify the above statement is true, correct and complete.
County Township
City. Belle ama Zip Cone
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 (one) acre immk.Liatelv
surrounding residential improvements � T
Other Land
Total Land
Residential Improvements
MAY
Dwelling
AUDI 1ORTo I
Other Improvements
i
I- Improvements - Line (6) plus (7) equals (8)
1 hereby certify the above is true-. correct. and complete.
Signature of Asse55or
G/ o
True Cash Assessed —Momestead
Value Valuation Valuation
r
- ACTION BY AUDITOR -
3 - Z —S/
Dale
Date: &V 11. /9a'/