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Homestead_Coleman (2)FORM HC 10 19i9 To Be Filed in Duplicate
Prescrided By State Board of Ta, Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7'?
p
SEE BACK FOR FILING INSTRUCTIONS OOT�O
(We) 2 e —�—� Z�cAA2T' I certify that on the 1st day of
,
March, 19 -7—Y— I, (We). occupied as our principal pl ce of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Er owned
❑ are buying under contract
❑ have a beneficial,ir]terest in the taxpayer
Property Description
Taxing District (City owr}— Township):
Parcel Number
If buying on contract: Owners name line simple owner)
alot/�a -aoo-
my ( 9& stic-/ Township
or legal description shown on tax statement:
!�T lcJ i N
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:
certify the above statement is true,, correct and complete.
County Township
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 -
Land not exceeding 1 FILno$a tely
D
surrounding residential improvements 1979
Other Land MAY 15
Total Land
Residential Improvemd' I AUDITOR Dwelling
Garage
Total
Other Improvements
To—' Improvements - Line (6) plus (7) equals (8)
Mov certify the above is true. correct. and complete.
pl AS..,
True Cash
Value
(1) 4 C--'0
(z) 39 to 0
(3) V'� 41 U
(4) y98 6
(5)
(6) 99 yo
(7) a -/ fn
(s) —L
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
/7u
SON—%,grzg7ii%��
paigg,
S -- 7- 79
Date
Approved: T ss Date: Jr" 15— 7
