Homestead_OliverFORM HC 1D 1979
RescriCed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 -15?
E JACK FOR FILING INSTRUCTIONS
To Be Filed in Duplicate
WM
�f- I� �� ) 0 16- oo72r? -0o
Q(We) /�� Q 1 �- x ��' ��^ '�" ' certify that on the 1st day of
arch, 1�9 Y (We) occupied as it 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 interest in the
Property Description in '_
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
Township
or legal description shown on tax 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
certify the above statement is true, correct and complete
Street
.7r
Ciry, State and Zip Cooe � �/e � q
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) je, dam(
surrounding residenN�t9rtTtroen t
Other Land {3M� jyJ
True Cash
Valua
0 ) lz�f) –0-V
(2) —0—
Assessed Homestead
Valuation Valuation
�/ 7O
r°
f � y� - ACTION BY AUDITOR
U -
Approved: j / 7tic..e..�L-._..
�-S -moo -79
Daie
Date:/,, -,S—, 7 7