HomeMy WebLinkAboutHomestead_NossettFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board or Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 1"7
SEE BACK FOR FILING INSTRUCTIONS �(� _ 0 17 ?'y-_
S' o a
48 (We) &t `� c;7. f- certify that on the 1st day of
march, 19- I, (We) oc pied as .our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Gowned
❑ are buying under contract
❑ have a beneficial int est in the taxpayer
Property Description in County Township
Taxing District (City, Town, Township):
Parcel Number or. legal description show on tax statement:
44gA,�A, Oar. �� -Z
If buying on contract: Owners name (lee simple owner)
Contract recorded in Recorders Office - Record No. Paae
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:
G
certify the above statement is true, correct and complete.
e-
6
County
�l7tle�-
Township
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.
Land not exceeding 1 (one) acre
surrounding residential improveme
Other Land
Total Land
Residential Improvements
- FOR ASSESSOR'S USE ONLY -
True Cash
Value
i mripatj a..
Its
(2) �-
JUN 6 1979. (3)
Owel ng (4)
" age (5)
'r 6 )
Total
Other Improvements (7)
Te` I (Improvements - Line (6) plus (7) equals (8) (8)
I ,oy certify the above is truricorrect. and complete.
SigndWre of Alsol.r
- ACTION BY AUDITOR -
766 0
Assessed Homestead
Valuation Valuation
—0—
I
7
-40 —'J,
oaue.. -
Approved: 1•i Date: