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Homestead_Richardson (4)FORM HC 10 1979 To Be Filed in Duplicate Prescribed By State Board of Tax Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR.19� R SEE BACKji FOR FILING INSTRUCTIONS l ©/6 � 00 71/ 0 _ 00 �(We) '° ' �" -'rn / x "certify that on the 1st day of arch,'19-� I, (W occupied 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 County Township Taxing District (City, Town, Township): Parcel Number or legal description sha�nn/ on tax statement: If buying on contract: Owners name (fee simple owner) 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 certify the above statement is true, correct and complete. 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. - FOR ASSESSOR'S USE ONLY - True Cash Assessed Homestead Value Valuation Valuation Land not exceeding 1 (one) acre immediately surrounding residential improvement Other Land F I Total Land x 46 Residential Improvements JUN r, 1979 Owe lin Other Improvements T.- - Line (6) I.- y certify the above is Signature Of Assessor 9 r AUDIT (7) equals (8) - ACTION BV' AUDITOR - s ar �o -79 Date — Approved:— l��I n Date: Q-7/77