HomeMy WebLinkAboutHomestead_WarnsmanFORM MC 10 1979
PUSCF,bed By State Board of Tax Commissioners
To Be Filet in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19__1.4? A,/
SEE BACK FOR FILING INSTRUCTIONS 0AV — ONO 9,_ 0 t7
We) r' "'•-'certify that on the 1st day of
arch, 19 I, (We) occupied as o i ipal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We)Xowned
❑ are buying under contract
❑ have a beneficial interest in the
Property Description in ,1L1 At --- I J
Taxing District (City, Town, Township):
-" Parcel Number
If buying on contract: Owners name
my
Township
or legal description show on tax statement:
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:
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 improvements
TToftal Land F I L
Residential Improvements
UN 9 1979_
Total
Other Improvements ' ' r
AUDIT01
Tn'-' Improvements me 6) plus (7) equa s (S)
10- &y certify the above true. correct. ang7 complete.
Signawre of Assessor
App
True Cash Assessed Homestead
Value Valuation Valuation
(2) . 0 --
(3) /12 Q'"'o
- ACTION BY AUDITOR_::
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