Homestead_Thomas (2)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
SEE BACK FOR FILING INSTRUCTIONS CPO— o/0 2a "o CP
•(We) t- & Jz certify that on the 1st day of
March, 19 I, (We) occupied as our principal place of residence the following described real property for
which aJHoomestead Property Tax Credit is hereby being claimed:
I, (We) L7 Owned
❑ are buying under contract
❑ have a beneficial interes in the er
r
Property Description in taxpayCounty Township
Taxing District (City, Town, Township):
Parcel Number or legal � description shown on tax statement:
lilCthGt, • b.in.ta. o�c ��J A10 •✓�Z
If buying on contract: Owners name (fee 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
' hereby certify the
above
statement
is true, correct
and
complete.
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Address I %&y. State and Zip Cade
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 F T T M 1 T 1
True Cash
Value
(1) /a 5o
(2) —p_
Assessed
Valuation
—40—
Homestead
Valuation
11.o
Daze
—/— I
Date: ( /11/72