HomeMy WebLinkAboutHomestead_JulianFORM HC 10 1979 To Be Filed in Duplicate
Presented By Slate Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-;7f--
SEE BACK FOR FILING INSTRUCTIONS
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(� (We) /r�' certify that on the 1st day of
arch, 19-11- I, (We) occupied as our principal pla a 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 interest in the
as r.
Property Description
Township
Taxing District (City, Town, Township): v
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name 0- ample awned
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
hereby certify the above statement is true, correct and complete.
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'Signature Street Address City. Slate and Zip Code
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.
as FOR ASSESSOR'S USE ONLY -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre imme aIe 9
surrounding residential improvemedUM (1) /O 6 C9 3 6 0 &60
Other Land
Total Land
Residential Improvements
AU
Dwelling
Garage
Total
Other Improvements
Tnf I Improvements - Line (6) plus (7) equals (8)
I *by certify the aboA is true. correctnand complete.
Signature of Ass tar
Approved
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Date: