HomeMy WebLinkAboutHomestead_Simmons (2)FORM HC 10 1979
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 'ZF
SEE BACK FOR FILING INSTR
To Be Film in Duplicate
Otto - 010017-no
(We) certify that on the 1st day of
arch, 19 -7-7— I, (We) o cupied 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 inteWst in the taxpayer
Property Description in
Taxing District (City, Town, Township): Q
Parcel Number
If buying on contract: Owners name I` simple owner)
ty
Township
or legal description shown on tax statement:
Contract recorded in Recorders Office - Record
It 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.
Stare ana
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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
True Cash Assessed Homestead
Value Vahtatinn Valuation
(1) A "-0
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Date
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