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Home My WebLink AboutHomestead_VirdenFORM HC 10 1979 To Be Filed in Duplicate Prescribed By State Board or Tax Commissioners CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 SEE BACK �{ FOR FILING INSTRUCTIONS ©//G ;1, _ O / /Y _ O 0 �(We) '7/� v��, r \�—� •^� E c � � certif y that on the list day of arch, 19 --1A 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 Property Description in —�` �-^ County _ Taxing District (CitNwn, Township): i � i Township v Parcel Number or legal description shown on tax statement: \J,;-- If ' mow'% , 8 -i- 8 If buying on contract: Owners name I'- simple 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 I hereby certify the above statement is true, correct and complete. 'Signature Street Address city. State and Zip Gode 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 Residential Improvements True Cash Value (1) Soo (2) (3) Dwelling (4) Garage (5) Total (6) Other Improvements (7) Total Improvements - Line (6) plus (7) equals (8) (8) I 4&-by certify the above is true. correct. and complete. i Signature of Assessor - ACTION BY AUDITOR - a Assessed Homestead Valttatinn Valttatinn Date Date: • j / /jj�jj