HomeMy WebLinkAboutHomestead_StoneFORM HC 10 1979
Prescribed By Suite Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM
FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR
19 "/4
n
SEE BACK FOR FILING INSTRUCTIONS
0/00 .
O O
(We) I I certify that on the 1st day of
arch, 19-7-9, il , (We) occupied as our p 1 cipal 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 intarest in the taxpayer
Property Description
Taxing District (City, Town, Township): t/a
Parcel Number
If buying on contract: Owners name (tae simple owner)
Township
or legal description sTiown on tax statement:
. k'- / t-2.
Contract recorded in Recorders Office - Record No. Page
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:
hereby certify the above statement is true, correct and complete.
County Township
Individual either owns or 1s ouying under a contract tnat provloes ne 1s to pay Tne 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
(2)
True Cash
Value
Assessed
Valuation
a &0
— D— —O-
(3) io d—o
6—/—
Date
Date: ?"9
Homestead
Valuation
. .