HomeMy WebLinkAboutHomestead_KozarFORM HC 10 1979
Prescribed By State Board of Tae Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 191
SEE BACK FOR FILING INSTRUCTIONS O1(0 — OO (0;t O' O
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) 9 owned
❑ are buying under contract
❑ have a beneficial intere t in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
Contract recorded in Recorders Office - Record
2,k_.l certify that on the 1st day of
the following described real property for
my Township
A
v
or legal description shown on tax statement:
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:
hereby certify the above statement is true, correct and complete.
County Township
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 improvements
Other Land
Total Land
Residential Improvement I L
jUN 2 0 1979
Other Improvements
Tlmprovements -
I* r._..by certify the i
Signawre of Assessor
True Cash
VaIIIP
(1)
(2) —p —
(3) a 0 a
Assessed Homestead
Vahfatinn Valuatinn
Approved: � ') Date: '.4—.2%- -2 9
7