HomeMy WebLinkAboutHomestead_RoblingFORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 If
SEE BACK FOR FILING INSTRUCTIONS 0 /6 -oogy 00
certify that on the list day of
March, 19-4L7-- 1, (We) occupie as our principal plaV 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 iWerest in the
Property Description in_�
Taxing District (City, Town, Township):
Parcel Number
l
Township
A Alf r
or legal description shown ?fn tax statement:
#- ;2- Az� 17
If buying on contract: Owners name Dee 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:
® hereby certify the above statement is true, correct and complete.
'Signature
0
Address
County 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
Tnfnl I nnrl
True Cash
Value
(1)
(2) — O —
131 lOS"0
K10
76/a
Assessed Homestead
Valuation Valuation
—O—
�,�` 0 --
Daze
Date: � ZS��