HomeMy WebLinkAboutHomestead_SchmaltzFORM HC 10 1979
Hescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_%9
SEE BACK FOR FILING INSTRUCTIONS Q/(o —Do Q %4 _ ov
n
■(we) Y ertify that on the 1st day of
�Jfarch, 19 I; (we) occupied as our prin al place of residence the foll ing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have.a beneficial intere t in the taxpayer
Property Description in J County Township
Taxing District (City, Town, Township): V a
Parcel Number
If buying on contract: Owners name (fee simple owner)
or gal 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: County Township
hereby certify the above statement is true, correct and complete.
City. State and Zip
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
FILED
otal Land
Residential Improvements
ul 2 197 Dwelling
Q���
Garage
Total
Other Improvements AUDITOR
(/
True Cash
Value
(1) " O
(2) —O-
(3) 3�9
(4)
(5)
(6)
(7)
Tn ' Improvements - Line (6) plus (7) equals (8) (s)
*by certify the aboA is Nue. cArect. and complete.
Sig=ure of Assessor
Approved
Assessed Homestead
Valuation Valuation
.7SO
Date:
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