HomeMy WebLinkAboutHomestead_CorneFORM HC 10 1979 10 Be Filed in Ouplicale
Premibed By Slate Board of ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19
SEE BACK FOR FILING INSTRUCTIONS VU
"n5 pt o 2
.;We) — certify that on the 1st day of
March, 1 �, I, (We ccupied as our principal 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 (G4y-,- Ttwuti, Township):
Parcel Number
If buying on contract: Owners name " "e svmofe o .erl
t ,C,l't�m�✓y�.�Township
legal descriptYon shown on tax statement:
will III e 44 30 -3 -/� %Qe�
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
hereby c rtify6 the above statement is true, correct and complete.
Address
Township
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 -
Land not exceeding 1 (one) acre immel�
surrounding residential i Fv e�is E Other Land 1}
Total Land
.1U�' 211979
Residential Improvements Dwelling
AU age
Total
Other Improvements
provements t- Line (6) plus (7) equals (8)
certify the above is true. correct. and complete.
of Assessor
Approved
True Cash
Value
(2)
(3) 0 00
(5)
(6)
(7) s7 (8)
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
S"- 8' - 7
Data
Date: /��