Homestead_Johnson (2)FORM HC 10 1979
Prescribed By state Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-1f--
SEE BACK FOR FILING INSTRUCTIONS CIO — 00 SQ /_ao
0. (We) � C 9- b � X ' `J certify that on the 1st day of
march, 19--l-q, I, (We) occupied as our principal place f. residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
(We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Y-/ . T
Property Description
Township
n n —
Taxing District (City, Town, Township): (l
Parcel Number or legal description sh wn on tax statement:
6�t • �Z%
If buying on contract: Owners name (lee simple owner) Z 2.9 003 a-Gi
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
®hereby certify the above statement is true, correct and complete.
/I /) n n A
Township
and zip
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.
Land not exceeding f (on t i
surrounding residential imp em nt
Other Land
Total Land
- FOR ASSESSOR'S USE ONLY -
JUN 1 1979
Residential Improvements
- t ing
a-I�j(�Ir //y'�r AUDITO a age
Total
Other Improvements
Tr' -1 Improvements - Line (6) plus (7) equals (8)
1 oby certify the above )q true. correct. a,9d complete.
Signature of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
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Date:
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