Homestead_WardFORM HC TO 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 83 . f
place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Gowned
❑ are buying under contract
❑ have a beneficial inter es in the taxpayer Q
Property Description in r County — Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax tatement:
of q- i L /Z 7 -12
If buying on contract: Owners name " simple, ..n.0
Contract recorded in Recorders Office - Record No
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:
&ereby certify the above statement is true, correct and complete.
County Township
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 in- rovements
Other Land L .
Total Land dam'
Residential ImprovementilAR i 0 1?83 Dwelling
)4 . L) , ' r Garage
AUDITOR Total
Other Improvements
T�`,rnprovements - Line (6) plus (7) equals (8)
I h reby certify the _above is true. correct. and complete.
Signature or Assessor
Approved:.
(8)
e
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
io I 9 "b3
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Date: