Homestead_Willis (8)FORM HC 1D 1979 To Be Filed in Duplicate
Prescribed By State Board of Ta. Commissioners
CLAIM FOR HOMESTEAD - PROPERTY TAX CREDIT FOR YEAR 19 C/
If buying on contract: Owners name l'ee 51np1e 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
- I hereby certify the above statement is true, correct and complete.
nature Street Address Qty. State a 'Z,p 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)Lhcre &me &telyE
surrounding residential improvements
Other Land
Total Land
Residential Improvements al
r
Other Improvements
T ' Improvements - Line (6)
Ioeby certify the above isi
Signawre OI Assessor
ire Ing
AUDIf&age
Total
True Cash
Value
(1) e5 -0--0
(2) .0—
(3)
(s) 141113O
do
Assessed Homestead
Valuation Valuation
. •
" -
Date: — / �/
SEE
BACK FOR FILING INSTRUCTIONS
I, (We) ❑ owned
❑ are buying under
contract
❑ have a beneficial
inte est it n
the taxpayer
Property Description in
R=—Count
Township
Taxing District (City, Town,
Township):
Parcel Number
or legal description shown on taQ
statement:
33 w /_,4 Sew
If buying on contract: Owners name l'ee 51np1e 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
- I hereby certify the above statement is true, correct and complete.
nature Street Address Qty. State a 'Z,p 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)Lhcre &me &telyE
surrounding residential improvements
Other Land
Total Land
Residential Improvements al
r
Other Improvements
T ' Improvements - Line (6)
Ioeby certify the above isi
Signawre OI Assessor
ire Ing
AUDIf&age
Total
True Cash
Value
(1) e5 -0--0
(2) .0—
(3)
(s) 141113O
do
Assessed Homestead
Valuation Valuation
. •
" -
Date: — / �/