HomeMy WebLinkAboutHomestead_Martin (20)FORM HC 10 1979
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �15P
To Be Filed in Duplicate
SEE BACK FOR FILING INSTRUCTIONS Q t 6. IDO ?O- O O
(We) , �- a , ' L'
9 o✓ certify that on the 1st day of
arch, 199, I, (We) occu ied as our prin pal 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 st in the taxpayer
Property Description in County �p Township
Taxing District (City, Town, Township):
Parcel Number
or legal description sh6wn on tax statement:
�"Lk pj-.A .r-.. !/ ,t...i✓" Lam,
If buying on contract: Owners name uee simple owner
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 property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
True Cash Assessed
Value Valuation
Land not exceeding 1 (one) arra iyettellp
surrounding residential improv ent „ '70
Other Land J' J6 i+ (2) —0— — D —
Total Land itt._ 121979 (3)
Residential Improvements (a)
(6)
AUDI (6)
Total
Other Improvements (7)
T ' ' Improvements - Line (6) plus (7) equals (8) (8)
I *by certify the above is tfte. correct. and jomplete.
Signature of Assessor
Homestead
Valuation
a s- 7q
Oat, _
L Q/)
Approved: Date: �