Homestead_Miley4 HC 10 1979
- FOR ASSESSORS
USE ONLY -
To Be Filed in Oupiicsce
Scribed By State
Board of Tax Commissioners
or legal
description shown on tax statement:
Value
end not exceeding 1 (one)
CLAIM FOR HCMESTEAD
PROPERTY TAX CRMIT FOR YEAR 19_
13,2--o
SEE BACK
FOR FILING INSTRUCTIONS
00'709- 00
)
�
owners name (fee simple
owner)
certify that on the 1st day of
rc 19 1, (Tile) occygied as our
operty for which a Homd9tead Pro
i cioal place of residence
Credit is hereby being
the following described real
claimed:
(Tie) 0 owned
M are buying under contract
have a beneficial interest in the taxpayer .
operty Description in C� County
zing District (City, Tom, Township):
Township
reel thanber
- FOR ASSESSORS
USE ONLY -
(8) a
certify the above
is true, correct,
or legal
description shown on tax statement:
Value
end not exceeding 1 (one)
acre immediately
13,2--o
rrouniing residential inprovements
-T
(1)
buying on contract:
owners name (fee simple
owner)
(2)
Contract
recorded iii Recorder's
Office - Record No. Page
any portion of the
residential structure or the land,
not exceeding one (1) acre that
mediately surrounds
that structure is used
to produce
inane, describe the use and portion of
:e property utilized
to prodw� income
.y other counties in which individual awns or buying real property: Coon Ttn mship
certify the'above statement is true, correct and ceaplete.
*Individual either awns or is buying uner a contract that provides he is to pay the
property taxes on the residence, or has a beneficial interest in the taxpayer.
improvements - Line
- FOR ASSESSORS
USE ONLY -
(8) a
certify the above
is true, correct,
True Cash
complete.
Value
end not exceeding 1 (one)
acre immediately
13,2--o
rrouniing residential inprovements
(1)
her Land
(2)
>tal Land
(3)
3J-0
!sidential Improvements
Dwelling
(4)
2 2
Garage
(5)
Total
(6)
O
her Improvements
(7)
improvements - Line
(6) plus (7)
equals (8)
(8) a
certify the above
is true, correct,
and
complete.
- ACTION BY Q.UDITnR -
Assessed
Valuation
V 4-o
y d�'y
Date
Homestead
Valuation
q-V o