Homestead_BerryFORM HC 10 1979
Prescribed By Sule Board of Fax Commissioners
To Be Filed in Ouplicale
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 197`2
SEE BACK FOR FILING INSTRUCTIONS e)os • °a a 9
�(We) .. it +� –�' - �A K/ certify that on the 1st day of
march, 19 I, Oill c principal place of resi ence 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 I res in the taxpayer �q-
Property Description in �' yt� —,/— County /;i��x�t Township
Taxing District (City— Towr-- Township) �� ° . a on
Parcel Number
If buying on contract: Owners name ued simple owner)
or legal description shown on tax statement:
i /1/Eie o?G -A -/a - /o.oy6ne
Contract recorded in Recorders Office - Record No
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
hereby certify the above statement is true, correct and complete.
'Sigwmr Street Addree5 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.
- FOR ASSESSOR'S USE ONLY -
True Cash
Value
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) o a
Other Land MAY 18 19790 _/ 326
Total Land (3) 5' '70
_
Residential Improvements
Zt— AUDIT _
Garage
Total (6) d O SAO o
Other Improvements (T) / o-n
T' Improvements - Line (6) plus (7) equals (8) (a) / 6 G O
Ioeby certify the above is true, correct. and complete.
gnat . of Assessor
%% ACTION BY - AUDITOR -
Approved: ( >
Assessed
Valuation
/7 D
gzo
Goa 99°
Homestead
Valuation
5 =s -- 7);1
oa:e .
Date: 60–