Homestead_LeeFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 '7f
SEE BACK FOR FILING INSTRUCTIONS 0 /(0 - 00(0 3 9- o a
®(We)� ^ r c- 0' 9 � certify that on the 1st day of
vtarch, 7y___7_9 I (We) occupied as our principal place of residence the following described real property for
which a__Hommestead Property Tax Credit is hereby being claimed:
I, (We) Downed
❑ are buying under contract
❑ have a beneficial inter st in the taxpayer
7
Property Description in a County — � Township
Taxing District (City, Town, Township): U
Parcel Number
or legal desc
41 -7 /d v
riptYon shown on tax statement:
If buying on contract: Owners name (fee simple owner) v 7n�
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that J 90
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.
'Signor Street Address Cu 0f. State and Zip Code
I
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 ,�
it 11
Residential Improve nte�ts� Ldp
Other Improvements /y/zs
To "' Improvement3 - ) p usA btgcoals (8)
10by certify the.ab true. cofiect. and c
Signature of Assessor
True Cash Assessed Homestead q
Value Valuation Valuation 96
(1) X770 ,--
(2) AEFV—� /n
Date: &' —Z 2 - 7 1?