Homestead_TrenthamFORM HC 10 1979 To Be Filed in Duplicate
Prescri0ed By State Board al Ta. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
y SEE BACK FOR FILING INSTRUCTIONS 016 - 0109 7-0Z)
(We) -8 • � certify that on the 1st day of
arch, I, (We) occup d 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
Property Description in c6/A -c-r-,J County
Taxing District (City, Town, Township):
Township
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name Dee Birtiptp owner)
Contract recorded in Recorders Office = Record No. Paae
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
Preby certify the above statement is true, correct and complete.
Ij
-S. 1- .5- di:-'�
County Township
ON
and
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 (od are im2al�l�
surrounding residential i ro L
Other Land MAY 11 ic.
Total Land
Residential ImprovedN10•
AUDITOR Dwelling
Garage
Total
Other Improvements
T11 Improvements - Line (6) plus (7) equals (8)
1 l,-.zby certify the above is true. correct. and complete.
Signature of Assessor
True Cash Assessed
Value Valuation
(1) `1S o
(2)
(3)
(4)
(s)
(6)
(7)
(8)
/So
- ACTION BY AUDITOR -
oate
Date:
Homestead
Vnhinlinn
/So
- cY - <S /'