HomeMy WebLinkAboutHomestead_RisingerFORM HC tO 1979
Rewribed By State Board of Tax Commissioners
To Be Filed in Oupinute
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 757
SEE BACK FOR FILING INSTRUCTIONS
KJO(We) / w b'- Zr� certify that on the 1st day of
March, 19'2, I, (mq occupied as our principal place of residence the following described real property for
cihich a Homestead Property Tax Credit is hereby being claimed:.
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description
�r-
Taxing District {.City —Town, Tnwnghi n):
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name (tee $tnp1e 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.
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 -
True Cash Assessed
Value Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other Land LED
Total Land
Residential Improvements
(;( i979Dwelling
G age
Other Improvements AUDITOR
T�' Improvements - Line (6) plus (7) equals (8)
1
Tr'
certify the above is true, correct. and complete.
Signature of A..,
ACTION BY AUDITOR -
Approved
__�•
-.
Homestead
Valuation
Date: C,� /-