HomeMy WebLinkAboutHomestead_ShouseFORM HC 10 1979
Prescribed By Slate Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�`L
^ x , SEE BACK FOR FILING O INSTRUCTIONS ON — 000/ s _ OD
®(We) certify that on the 1st day of
elarch, 19—:M (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 irftrest /.in the taxpayer
Property Description in �.�� -�+^' County Township
Taxing District (City, Town, Township): 0
Parcel Number or legal description shown od tax statement:
. '6---Z
If buying on contract: Owners name flee simple owner)
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
I hereby certify the above statement is true, correct and complete.
in
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 Assessed
Value Valuation
Land not exceeding rsier 1 (imprrmil l�diat�l� D
surrounding residential imp r m is �MJ
Other Land (2)
Total
JUN 12 1979
Residential Improvements
Inn
AU�g e
Other Improvements
AImprovements - Line (6) plus
by certify the above is true./
Signature of Assessor
(3) '3 J
Date
Date:
Homestead
Valuation