Homestead_Chamberlain (5)FORM HC TO 1979
Poescr@ed By State Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 '-17"?
ooh -�a�`I
A n , n A
SEE BACK FOR FILING INSTRUCTIONS
Fwe) certify that on the 1st day of
March, 19-2-�-', I, (We) occupied as our pr cipal 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
Taxing District (Gity -Tewa- Township): �k Y
Parcel Number
If buying on contract: Owners
(fee simple owner)
"? - //- 40
Township
or legal description shown on tax statement:
24-. AJF
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
certify t
is true, correct and complete.
State and Zip Doce
65
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 -
���°°°ppp TT T True Cash Assessed Homestead
{,�_ T Value Valuation Valuation
Land not exceeding 1 (o ac I L d L _
surrounding residential improvements
Other Land MAY 181979 (2) 3 i c-,*-' d �
Total Land
Residential Improvemen /
AUDITOR ellinng
Garage
Total
Other Improvements
Tr ( mprovements - Line (6) plus (7) equals (8)
Ioy certify the above„is true. correct, and complete.
t a or Assessor
Approved:
(g) 3 o�
(4) 9890
(5)
(7) —
(8) 1 9 8 90
- ACTION 13Y AUDITOR -
11
— ) 014
�- -7 -79
Date
Date: — �O