Homestead_SchenksFORM HC 10 1979
Prewrioed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT. FOR YEAR 19-2y—
SEE BACK FOR FILING INSTRUCTIONS 0 //_ _DOLTS_ 00
�,. (O
R(We) IUA4 -�J-eI Y/. 4- �Q/till-tthet. Oar a- t•ertify that on the 1st day of
19 -Q, 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) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the
y�
Property Description in ounty Township
Taxing District (City, Town, Township): (//�1
Parcel Number or legal description shown gn tax statement:
44, - 13
If buying on contract: Owners. name (toe simple owner)
Contract recorded in Recorders Office - Record No. Paqe
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:
®by here certify the above statement is true, correct and complete.
Street Address
County Township
City. State and Zip code (1 —4V147/L,
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 improvemants,
Other Land FILED
Total Land
Residential Improvements .illN' 2 (wall'
Ing
Gara
Other Improvements AUDITOR
T� Improvements - Line (6) plus (7) equals (8)
l octly certify the above is true./torrect. and c
Signature of Assessor
lete.
True Cash Assessed
Value Valuation
(1) 4&-o
(2) 10-
(3)
(4)
(5)
(6)
(7)
(8)
�0
—0
1.30
- ACTION BrAUDITOR -
Date
Homestead
Valuation
/30
Approved: / � Date: /' - : i