Homestead_ThorneFORM MC 10 1979
Prescribed By Stale Board of Tar Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�4�71
SEE BACK FOR FILING INSTRUCTIONS 0/to - 0/090- OD
(We) )6-, �— e' � X certify that on the 1st day of
March, 19 7, I, (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 interest in the taxpayer
;-1 / i.
Property Description i
Township
Taxing District (City, Town, Township): Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name It" simple owner)
Contract recorded in Recorders Office - Record No. Page
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.
As
Street Addreaa
City. Sude and Zip code
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 FILED
Total Land
Residential Improvements Dwelling
JUN 281979 Garage
Total
Other Improvements AUDITOR
,T Improvements - Line (6) plus (7) equals (8)
"by certify the abovA is true. correct. and complete.
Signawre of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
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Date: