Homestead_HoughlandFORM HC 10 1979
Prescribed By Slate Board of iar Commissioners
To Be Filed in Duplicate
(CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19'
l SEE BACK FOR FILING INSTRUCTIONS 0 0SSl��c7
f(We) certify that on the 1st day of
M rch, 19--17-7– I, (We) 4Vccupied as our prin pal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial in rest in the taxpayer
Property Description in County
Taxing District (City, Town, Township): a-- k --6,eL
Parcel Number
If buying on contract: Owners name 1l- simple owner)
Township
or legal description sxown on tax statement:
. a 4J 94_A_ . 3 h•3
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: County Township
I I hereby certify the above statement is true, correct and complete.
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 immediately
surrounding residential
Other Land
i� enIq
1
Total Land
Residential Improvements
IUA 2 5 1979 Dwelling
a� /rage
I/ AUDITOR otal
Other Improvements
To' -' Improvements - Line (6) plus (7) equals (8)
1,06y certify the above is lrtA. correct. and 5
Signature of Assessor
Approved
True Cash
Value
(1)
(2) — D
(3)
(4)
(6)
(6)
(7)
(8)
i�
Assessed Homestead
Valuation Valuation
Date
Date: 9