HomeMy WebLinkAboutHomestead_SloanFORM HC 10 1979
Prescribed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7
r/ SEE BACK FOR FILING INSTRUCTIONS ot8- 00393 -0G
(We) �/, �< certify that on the 1st day of
March, 19'3 I, (We) occupied aq 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 interest in the taxpayer
Property Description i
Taxing District (C -ity, Town, �ewrrshrp): y�CZ
Parcel Number
TR"ti Township
or legal description shown on tax statement:
Al
L
If buying on contract: Owners name 0- simple owner)
Contract recorded in Recorders Office - Record
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.
® \ 1/i/�.G1 � �!i'4 -��/i- ri2 L� �J �✓ :�r-t !v+-�.
'SIg . t � S:reet Atltlress '
City. State and Zip 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.
•e•. ." ..:' ONLY
L)
Land not exceeding 1 (one) acre immediately 5 1979
surrounding residential improvements,
Other Land /
Total Land AUDITOR
Residential Improvements Dwelling
Garage
Total
Assessed Romestead
Valuation Valuation
(6)IS�O tea-
Other Improvements (7)
Tr.'-' Improvements Line (6) plus (7) equals (8) (8)
Toby certify the above is true. correct. and complete.
.Si9pature.o1-Assessor
- ACTION BY AUDITOR -
a7oQ-
oa:e 0
Approved: A/ (1, Date:
True Cash
Value
(2)
-
(3)
%moo
(4)
(5)
Assessed Romestead
Valuation Valuation
(6)IS�O tea-
Other Improvements (7)
Tr.'-' Improvements Line (6) plus (7) equals (8) (8)
Toby certify the above is true. correct. and complete.
.Si9pature.o1-Assessor
- ACTION BY AUDITOR -
a7oQ-
oa:e 0
Approved: A/ (1, Date: