Homestead_Campbell (3)FORM HC 10 1979 \ To Be Filed in Ouplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
SEE BACK
y FOR FILING INSTRUCTIONS
�(We) �` `^ 2. V S• certify that on the 1st day of
larch, 19--K-1 I, We) occupied as our principal plac 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 in rest in the taxpayer J
Property Description in —County Township
Taxing District (City, Town, Township):
Parcel Number
If buying on contract: Owners
or legal description shown on tax statement:
(?' - j w '% 3 - j - / :2- s- yt:.v
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
'Signature / Street Address City. State am 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 Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) S9 / 7o �D
Other Land (2) Al6 0 0
Total Land (3) i 6 oa �S
Residential Improveme����� (a) /� 7a
Dwelling —�
Garage (5) 3 3 o
MAR 3 1 1981 Total
(6) // S 0 0
Other Improvements Improvements (7) / a o o 4/-
Total Improvements )II.inE)Q6 (8) (8) / a 7 0 0
I.by certify the above is4�49bT@8r t. a qd complete.
Signature Signature of Assessor Dare
ACTION BY AUDITOR_:
proved: Date: