Homestead_NixonFORM HC 10 1979 To Be TOM in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_'7f
SEE BACK FOR FILING INSTRUCTIONS O/(0— 00'7(0 07, O'O
-®(We) "' ¢� certify that on the 1st day of
March, as o 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 i terest in the taxpayer
Property Description in County Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax statement:
1—/v
pee simple owner) -F�
If buying on contract: Owners name ��-
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:
hereby certify the above statement is true, correct and complete.
' 'Signature Street Andress
County Township
and Zip Ceee
'_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 e m edia
surrounding residential imp a tssL
Other Land
Total Land JUN 121979
True Cash
Value
(2) "J O
(3)
�o
Assessed
Valuation
s176�v
Homestead
Valuatinn
/Zo /30
NVEWTOW. =If
Date
Date: 10 1