Homestead_Chamberlain (6)FORM HC 10 1979 to Be Filed in omilicate
Prescribed By Slate Board of tar Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19Z?
SEE BACK FOR FILING INSTRUCTIONS �5� OOas.3
�(We) _.o, G11 'F w�� Jam certify that on the 1st day of
March, 19-:??— I, (We) occupied as our prin al plat 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. 7f�
Property Description in County b o 4:)oA Ati! Township
Taxing District te4y- T1&wa�Township):
Parcel Number or legal
If buying on contract: Owners name ifee simple owner)
shown on tax statement:)'
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 -
True Cash
Value
Land not exceeding 1 (one) acre immediately
surrounding residential improvements S o u
Other Land
Total Land (3) tai a O
Residential Improvements ��N1 9979 (q) �yt Sljp
Garag ( �0
i; r !ta/
i, y 7 i O
Other Improvements AU1D1j a �O
0 Improvements - Line (6) plus (7) equals 8) (8) % _/81 O
eby certify the above is true. correct. and complete.
of As..,
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
6
,J —7 -7 9'
Dare
Date: (c,c'.A.- s 7 9