Homestead_Mason (2)FORM HC 10 1979
Prescriloed By State Board of Tae Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 82- ✓�
SEE BACK FOR FILING INSTRUCTIONS 0,(0 _ Oo[o % '/- pa
(We) / Y
of resid I
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � —County
Taxing District (G y-,, Town, Township):
— certify that on the 1st day of
following described real property for
C Township
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name If" simple owner) T Z — Z
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
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:
I hereby certify the above statement is true, correct and complete.
'Signature
' µ Street Address
County Township
and
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 Improvements Dwelling
Garage
Total
True Cash
Value
000
(2)
(3) / �o
(a)
(s)
(6)
Other Improvements (7)
jotal,Improvements - Line (6) plus (7) equals (8) (8)
Ileby certify the above is true. correct. and complete.
Signature of Assessor
Assessed
Valuntinn
�o
- ACTION BY AUDITOR -
Date
Approved: Date:
a.
Homestead
Vahlatinn
C;=-