Homestead_Rowe (2)FORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-7-9
SEE BACK FOR FILING INSTRUCTIONS O/& _ 0 0 C1Sp. �C
�Ve) y�,, ) �ti� )�< certify that on the 1st day of
ch, 19-_—Z-,Q I, (We) occupied as our principal place of residence the following described real property for
which a— H /omestead Property Tax Credit is hereby being claimed:
I, (We) f/ owned
❑ are buying under contract
❑ have a beneficial O esS)in the taxpayer /?
Property Description
Taxing District (Gity
Parcel Number
If buying on contract: Owners name Tire 52"o
Township
or legal description shown on tax statement:
7
Contract recorded in Recorders Office - Record N
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
I hereby certify the above statement is true, correct and complete
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
Total Land �j
Residential Impro emer�s `L�
Other Improverr>
e
JUL 111979
4 p u� s (8)
is truLA.LQTQ&. and complete.
True Cash
VAII1F
(2)
(3) J� &-a
- ACTION BY AUDITOR_::
Assessed
Valuafinn
/70
Homestead
Valuation
1,26
60-
Date: // --
G