Homestead_ReedFORM HC 10 1979 To Be Filed in Oupliwte
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
SEE BACK FOR FILING INSTRUCTIONS
So .. ce,, 0/6- DQ 246-00
,(We)4J�"�/4, '` rtify that on the 1st day of
March, 14L-,7-9!- I, (We) occupi d as our 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 taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name 2- simple owner)
Township
or lle}gaal c
l description shhoWn ion tax statement:
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: County Township
y certify the above statement is true, correct and complete.
fin- ��2 . 1 4✓ Li -76CO
re Street Address Ci y. State and Zip Cooe
& - /f-- 79
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
Value
Land not exceeding .1 (one) acre immediately
surrounding residential improvements (1) 90
Other Land (2) —
Total Land FILED (3)
Residential Improvements (4) Z3
JUN 1- ffl� g (s) kt9-�o
Total (6) /3 � 3 0
y
Other Improvements r 4-j f— R (7) \
T Improvements - Line (6) plus ( equals (8) (8)
10, by certify the above is trueAcorrect, and copplete.
Signature of Assersor
LOP
AUDITOR -
Assessed Homestead
Vahtatinn Valuatinn
4�3D
_0—
Date
Approved: le Date: ,- //F- 7�