Homestead_OffilFORM HC 10, 1979
Prescribed By Stale Boaro of iaR Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1g -Z`L
March,
is hereby being claimed:
I, (We) ® owned
❑ are buying under contract
❑ have a beneficial in est in the taxpayer
Property Description in
Taxing District (City, Town, Township):
To Be Filed in Duplicate
0110- 00'18810V
certify that on the 1st day of
following described real property for
0
Township
Parcel Number or legal description shown on tax statement:
7 -
/-s-
If buying on contract: Owners name Dee 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:
0 L-hereby certify the above statement is true, correct and complete.
'Signature
Address
County Township
arM Lip Code
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
0
True Cash Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (ofC� t�Tmetl�aRly�'1
surrounding residential i ov e s �F1J JL.�) (1) SITD %O p
Other Land (2) —0— —O—
Total Land JUN 16 1979 !�Q (3) 6 e-o /70
Residential Improvement ling (4) / d
' ' g`'`arage (5)� �
AUDITOR (el Y ! 0 �7—/ o
Total Other Improvements (7) Ze Tr'-' .Improvements - Line (6) plus (7) equals (8) (8)
Ieby certify the.above is correct. and co fete.
Lb
Signature of Assessor Date
- ACTION BY AUDITOR -
Approved:. i�o Ln Date:--- ������_