Homestead_Miller (6)FOAM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAO PROPERTY TAX CREOIT FOR YEAR. 19 %9 ✓
SEE BACK FOR FILING INSTRUCTIONS 0/ /Q —0 0&'? F- Q a
A . e / )
RR(We) / """-"'"�`' certify that on the 1st day of
19�,�, I, ( e) occupied as our principal 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 interest in the
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name 11" simple owner)
Township
or legal description shown orU tax statement:
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: County Township
0hereby certify the above statement is true, correct and complete.
'Signtiture Street Address
City. State 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 -
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceepg 1 (one Dacre ne tely
surrounding res nti lmp vem
Other Land
Total Land _ I!r; 1979
Residential Improvements Dwelling
Garage
AUDITOR Total
Other Improvements
T�' ' Improvements - Line (6) plus (7) equals (8)
I0,by certify the above is true. correct. A complete.
Signature of Assessor
(1)
(2) o —
(3) SSO
(4)
(5)
(6)
(7)
(8)
/L O
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-s .2q -7%
Date
Approved: /�cc. Date: ; 1929