Homestead_Woods (2)FORM HC 10 1979
Prescritieo By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1g 1L
To Be Film in Duplicate
SEE BACK FOR FILING INSTRUCTIONS Q// - 01a a0_ 00
(We) "" � certify that on
the 1st day of
�arch, 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 interes in the taxpayer
Property Description in —Punty
Taxing District (City, Town, Township):—
Township
Parcel Number or legal description shown 9 tax statement: _ �J
If buying on contract: Owners name fee 5inip1e owner)
Contract recorded in Recorders Office - Record No. Paoe
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:
hereby 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 exceefg 11(one)Lre teDly
surrounding residential improvements (1)
Other Land JUN 12 1979- (2)
Total Land // (3)
Residential Im4'jX� Dwelling (4)
AUDITOR Garage (5)
Total (6)
Other Improvements (7)
T Improvements - Line (6) plus (7) equals (8) (8)
A'' eby certify the above is true. coact. and complete.
Signature of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
- Z/ - ?L
Date
Date: 4O -/19 -