HomeMy WebLinkAboutHomestead_BlankenshipFORM HC 10 1979 To Be Filed in Duplicate
Preuribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
Q SEE BACK FOR FILING INSTRUCTIONS rNl -60 j3
b(We)Xa"` a -°�` 1a °h �- °4 certify that on the 1st day of
, rch, 19 7!I, (We) occupied f&s our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: // 4
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in — County c� �?2� Township
Taxing District (City, Town, Township):
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name tfee simple owner)
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
�I hereby certify the above statement is true, correct and complete.
V - -
ocreer naaress
Township
miry, mace ano fp woe
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 exceeding 1 (one) acre immediately
surrounding residential Prfements
Other Land E
Total Land
Residential ImprovementsMAY 10 1982
Na Dwelling
N®, Garage
AUDITOR Total
Other Improvements
Total Improvements - Line (6) plus (7) equals (8),
1 ®by certify the above is true. correct. and complete.
Ck�) 6ta�e4j
Signature of Assessor
Approved:
(5)
(6) 2 3 t-
(7)
Assessed
Valuation
/70
Homestead
Valuation
(8) X36, 7 0 2–s—'7-a
- ACTION BY AUDITOR_:
Dare
Date:
True Cash
Value
(1)
So 0
(2)
—
(3)
So 0
(a)
.23(,/0
(5)
(6) 2 3 t-
(7)
Assessed
Valuation
/70
Homestead
Valuation
(8) X36, 7 0 2–s—'7-a
- ACTION BY AUDITOR_:
Dare
Date: