Homestead_Byrns (4)FORM HC 10 19i9
Presented By State Board of iav Commissioners
To Be Fit% in Oupficate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19Z!F
SEE BACK FOR FILING INSTRUCTIONS
(We) /�(�,c certify that on the 1st day of
arch, 1, (We) occupied as our prdWipal place off7esidence the following described real property for
which a Homestead Property Tax Credit is hereby being, claimed:
I, (We) ❑ owned
C3 are buying under contract
❑ have a beneficial /interey in the taxpayer
Property Description i
Taxing District (G#r Team, Township):
Parcel Number
e,-9- Al
my Township
or legal description shown on tax statement:
If buying on contract: Owners name 1'04-6-7— Y1��4 y 1�A/V� �r.J� �.S ✓ /� /�
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
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 -
Approved: �\
Assessed Homestead
Valuation Valuation
s-- 7- 79
—Date —
Date:
True Cash
Value
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
(1) J o a
Other Land FILE �
Total Land
(2) al s— a
(3)
Residential Improvements
Dwelling
(4) /64-4
i U L 31979
Garage'
(5) — —
Total
(6) _/ ,S O
(/J
Other Improvements ' j' ' AUDITOR
(7) a y -7LO-
ine plus (7) equals
T Improvements ine
(8)
(8) y/ .6
A(6)
� Eby certify the above is true. correct. and complete.
Sign re of Assessor
n J
ACTION
BY AUDITOR -
Approved: �\
Assessed Homestead
Valuation Valuation
s-- 7- 79
—Date —
Date: