HomeMy WebLinkAboutHomestead_YoungFORM HC 10 1979
Prescrnaed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19—Zj—
arch, 19 I, (We) occupied as our principal place of res en,
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest In the taxpayer
X/r/ r
IONS
To Be Film in Duplicate
016 -0iaL3y -oo
certify that on the 1st day of
ing described real property for
Property Description in x N`4 -e-w
County
Township
Taxing District (City, Town, Township):
Parcel Number
or legal
description
shown on x statement:
If buying on contract: Owners name it. simple owner)
P
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:
certify the above statement is true, correct and complete.
Address City. Stale and Ip e
Individual eith ns or s 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 -
True Cash
Value
County Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land
Total Land F I L E ID
Residential Improvements 31979 Dwelling
Garage
�/ Led� Total
Other Improvement�/ AUDITOR
T ' Improvements - Line (6) plus (7) equals (8)
1- .by certify the above is trueAcorrect. and complete. a
Signature of Assessor
Approved:
(1) /}EO
(2) —
(3) —/4/ O
(4)
(5)
(6)
(/)
(8)
Assessed
Valuation
'><90
590
Homestead
Valuation
6 -1- 7y
Dale
Date,
%11