Homestead_Norrick (2)FORM HC 10 1979
Prescribed By Stale Board of ta. Commissioners_
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 8
SEE BACK FOR FILING INSTRUCTIONS
F
To Be Filed in Duplicate
o /b- 0077y -0o
.'We) "�``��� certify that on the 1st day of
March, 19 Po I, (We) occ ied as our principal place of resi nce 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 taxpayer
Property Description in ,A n County Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name Pee simple owner)
or legal, description shown on taz statement:
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 Township
hereb/yy cert' y the bove statement is true, correct and complete.
i . vs�tivfL o �, c f Al 7C-60
,gnature I Street Address City. Sta an0 ip CPdc
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 exceeding 1 (one) acre immediately
surrounding residential improvements (1) 3G o ___ /0
Other Land (2)
Total Land ED (3) d�0 0,143,6 Residential I v (a) /� -3470
Dwelling tA�.�(7 - Garage (6) %
Total (6)�A
Other Improv6Rf�nt r AUDITOR (y) \
4Improvemen - Line (6) plus (7) equals (8) (g)
6y certify the above is true. correct. and complete.
/oi
Signature or Assessor Dare --
-ACTION BY AUDITOR -
Approved: Date: