HomeMy WebLinkAboutHomestead_Kell (2)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 191 J
n 9SEE BACK FOR FILING INSTRUCTIONS 0/6— (% 00
I (We) /� � �° �� �` �` certify that on the 1st day of
tiavlarch, 19 I, (We) occupied as our principal 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 inte est in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
Township
or legal description shown on tax statement:
i1,%j,H�J fit)
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.
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 imprm�ts (1)
Other Land (2)
Total Land (3)
'_ ? 1979
Residential Improvements Dwelling (4)
(5)
al (6)
Other Improvements AUDITOR (7)
Tr} 1 Improvements - Line (6) plus (7) equals (8) (8)
1 by certify the above iiA true. correct. pnd complete.
Signature of Assessor
I
O
True Cash Assessed Homestead
Value Valuation Valuation
S 24-71
Date
Date: