Homestead_McClureFORM HC 10 1979
Preuribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 79
SEE BACK FOR FILING INSTRUCTIONS 0/(0 —00730— 0-0
a _
.(We) - V' t^ c x' (% �t � certify that on the 1st day of
march, 19 I, (We) occupied 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 e t in the taxpayer
r J
Property Description in
Taxing District (City, Town, Township): 0.
Parcel Number
If buying on contract: Owners name (fee simple owner)
Township
or ,leg /al description shbWn on tax statement:
w' f°� �OiP -�- i�'' /if3 6
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:
herreby certify the above statement is true, correct and complete.
W
County
Township
Zip Cafe
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.
Land not exceeding 1 (one)
surrounding residential imp
Other Land
Total Land
Residential Improvements
- FOR ASSESSOR'S USE -ONLY -
at le t,ED
rov nt
u ►N 71979
1 e
/ .
�:.: r'e
Total
Other Improvements
T�' ' Improvements - Line (6) plus (7) equals (8)
I0 by certify the above is true. Arect. and co
Signature of AswsSor
(1)
(2)
(3) L x_ 70
True Cash Assessed
Value Valuation
1 -370 X60
—O— --p_
(4)
(5)
(6)
(7)
(8)
Dare
0
Homestead
Valuatinn
r•�
Approved: Ak ' aJ a ^xvn Date: 6,17,/ 79