HomeMy WebLinkAboutHomestead_Montgomery (4)FORM HC 10 1979 To Be Film in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 192!
SEE BACK FOR FILING INSTRUCTIONS 0/6 _ DO r7/3 _ O D
(We) -e.- • f- rartify (that on the 1st day of
arch, 19-,I-�- I, We) occupied as our pri ipal place of reside a the fol wing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) qowned
❑ are buying under contract
❑ have a beneficial inter st in the taxpayer
Property Description in County Township
Taxing District (City, Town, Township): ��--
Parcel Number or legal description shown own ax statement:
If buying on contract: Owners name ttee simple owner
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
thereby certify the above statement is true, correct and complete.
'sign a Street Aopress L Clty. 9a• and rZip Dope
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) acrr n Idl telyE D
surrounding residential improvynts
Other Land
Total Land
Residential Improvements
Other Improvements
JON ..
AUD
.r�
Total
Tom' I Improvements - Line (6) plus (7) equals (8)
1®eby certify the above is IF el correct. nd c,�mplete.
�,tE.4�
Signature of Assessor
True Cash
Value
(1) .3 So
(2) — o —
(3)
(a)
(5)
(6)r0 \O
(7) �\
(8)
- ACTION BY AUDITOR -
Assessed
Homestead
Valuation
Valuation
la 49
10-
ao
S -a9 -7
Daie
Approved: \ 1I y� \T S4 T1wA Date: