Homestead_ColemanFORM HC 10 1979
Prewstred By State Board of lax Commissioners
To Be Fileo in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 71':�' .
SEE BACK FOR FILING INSTRUCTIONS 06M ,
���
- �
�— � / � , � � certify that on the 1st day of
March, 1922, I, (We) occupied as our principal p e oral t residence the owing described real property for
which a Homestead Property Tax Cyr@ is hrieb1 b�ing'�{ia med:
I, (We) ® owned 1� "j
❑ are buying under contract
❑ have a beneficial �ryterest in the taxpayer
Property Description
Taxing District {G4y- -nuua- Township):
Parcel Number
If buying on contract: Owners name (1ee simple °caner)
my �k9 Township
or legal description shown on tax statement:
W-3 7 ;I_
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
0hereby certify the above statement is true, correct and complete.
�1
3
Sueet Address
Stave and Zip
Indiviaual 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 -
�14
Land not exceedin 1 (oQyacre imrlleAia ly
surrounding rel improvRpte��s
Other Land "7
Total Land
Residential Improvements -41jol
R
Other Improvements
Dwelling
Garage
Total
rovements - Line (6) plus (7) equals (8) _
certify the above is true. correct. and complete.
of Assessor
True Cash
Value
(1) a 7 D
(2) - o -
(3) a 7 0
(4) <- // y
(5) IF 0--O
(6) 9%o
(7)
(8)10 9�v
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation.
o -
�O
-7 -79
Da:e
.;7 3i eg
Approved: A/ /I A� f�"t Date:AX�?/ 77