HomeMy WebLinkAboutHomestead_KnightFORM HC 10 1919
Prescri:ec By Sate Board of lax Conmissionels
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 -D-
SEE BACK FOR FILING INSTRU
10 Be Fded m Uuplcale
J)((Q_ p0(011 -00
Ve) ',IAA-Jk. 4 (7)&4-' certify that on the 1st day of
M. -rch, 19�, I, (We) occupied as our pri ipal place of re idence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) 0 ovmed
❑ are buying under contract
❑ have a beneficial interest Qin the taxpayer
Property Description in oM * County Township
Taxing District (City, Town, Township): CJ 1
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name Uee simple ovnerf
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
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(ptopertyjtaxes
on the residence, or has a beneficial interest in the taxpayer. ll
FOR ASSESSOR'S USE ONLY - AUD f) OR �S
Land not exceeding t (one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements
(1)
(2)
(3)
Dwelling (4)
Garage (5)
Total (6)
True Cash Assessed Homestead
Value Valuation Valuation
Other Improvements (7)
ToWrprovemems - Line (6) plus (7) equals (8) (8)
1 hereby certify the above is true. correct. and complete.
59eutore of Assessor '
ACTION BY AUDITOR -
P Z
Dan'
Bate: L' 30 =�!