HomeMy WebLinkAboutHomestead_NanceFORM HC 10 19i9
Prescribed By Slate Board of Tax Commissioners
CLAIM 'FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 '757
SEE BACK FOR FILING INSTRUCTIONS
To Be Filed in Duplicate
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R(We) ca, certify that on the 1st day of
arch, 19_1V_ I, (We 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 inters in the taxpayer
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Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name "ie 9np1e
Township
or legal description sf'iown on tax st tement:
Contract recorded in Recorders Office - Record
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
certify the above statement is true, correct and complete.
ti
Z.
Township
zip Cone
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
Fim Val ue
Land not exceeding 1 (one) acrmeediate y
surrounding residential improvements
Other Land JUN 6 1 979 (2) — —
Total Land (3)
Residential Improvements �r w ting (a) 3
�parageOR
Total
Other Improvements (7)
Tot I Improvements - Line (6)-plus (7) equals (8) (8)
I *by certify the above is true. rrect, and co fete.
Signature of Assessor —
ACTION B AUDITOR -
M
Assessed Homestead
Valuation Valuation
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Daze
Date: 6cp