Homestead_Richeson (2)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-1Z-
SEE BACK FOR FILING INSTRUCTIONS 016 - 009Q8- 00
(We) W ' t " ��
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 i
Township
Taxing District (City, Town, Township):
Parcel Number or l/eg��al description shown on tax statement:
If buying on contract: Owners name (fee simple owner)
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
hereby 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 -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land F LED
Total Land
Residential Improvements Dwelling
jU11 G to c
Garage
/) /Total
Other Improvements e r ti
T� Improvements - Lin (6) plus (7) e10%
r ,.,.reby certify the above is t#e. correct. anr2complete.
Signature of Assessor
True Cash
Value
(1) �O
(2)
(3) 419
(4)
(5)
(6)
(7)
(8)
�A-
Assessed Homestead
Valuation Valuation
/SO
—O—
/SO
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Date
Date: e� - Z 9- %�