HomeMy WebLinkAboutHomestead_RiddleFORM TIC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Dammissionefs
CLAIM FOR HOMESTEAD PROPERTY JAX CREDIT FOR YEAR 19 757 ✓
Q SEE BACK FOR FILING INSTRUCTIONS
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�,We) O `� /6•°`�"�'�ertify that on the 1st day of
march, 19--737- I, (We) 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) Browned
❑ are buying under contract
❑ have a beneficial inter st in the taxpayer
Property Description in
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners name f1ee simple owner)
ty
Township
or le I 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:
,;�hereby certify the above statement is true, correct and complete.
S`�
Signature y Street Address
County Township
�/7 00
Stale and Zip 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 -
True Cash
Value
Land not exceeding 1 ) Im rsurrounding residentialpr�ve ent (1) 00
Other Land 1 (2) —
Total Land JUN E 1979 (3)
Residential Improvement (a) 9 O
�j - �— Dwelling 7
Garage (s) 07 s0
AUDITOR n
Total ls> _/0 D 2, 02, O
Other Improvements (y)
' I Improvements Line (6) plus (7) equals (8) (8)
T
O O
;�eby certify the above is true. corre and complete.
L
Signature of Assessor a�/
ACTION BY AU ITOR -
Assessed
Valuation
—O—
Homestead
Valuation
Date
Date: