Homestead_HuffFORM HC 10 1979 To Be Filed in Duplicate
prescribed By State Board of Tar Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�
p)' SEE BACK FOR 'FILING INSTRUCTIONS ��6 — 00SS7-
*(We) Jam' >. y j& 4 f /
g stiJ certify that on the 1st day of
March, 19 -9 I, (W occupied as our principal place of r dence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
Mare buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in 64� County
Township
Taxing District (City, Town, Township):'
Parcel Number or legal description shown on tax statement: 1112
If buying on contract: Owners name free simple owner) J /— A — 3 —`r
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: County Township
'hereby certify the above statement is true, correct and complete.
�� dJ 230 AL XIjbE• Fe1AHrd of'T, Tjrl. �7l6�
]�'9gnamre
Sueof Address ANA. City. State and Zip Code
Individual either owns or is buying under a contract that provide3"Fl1111111iL`"pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash Assessed
Value Valuation
I and not avrppriinn 1 (nnp) arrp immpriiatply
Homestead
Valuation
Date: