Homestead_Creek (2)FORM HC 10 1979
Piescrihed By State Board of Tax Commissioners
To Be Filed in 0opliwre
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7�1 op3�IS
SEE BACK FOR FILING INSTRUCTIONS. 005
�We) certify that on the 1st day of
arch, 19 79 I, (We) cupied a ur princip lace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) 9 owned !/Xy ��/ 09 ,500 - (�Q• �i� –���
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in �' . � County
Taxing District (City; - TawP-, Township): —
Parcel Number
- If buying on contract: Owners
ownert
Township
or legal description 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
ereby certify the above statement is true, correct and complete. n '
J'Signature Street Address City. State and 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 (oP) acre immediate y
surrounding residential improvements
Other Land
Total Land
'N 2
Residential Improvements
l welling
G
AUDIT G rage
Total
Other Improvements
rovements Line (6) plus (7) equals (8)
certify the above is true. correct, and complete.
of Assessor
Approved:
True Cash
Value
(1) oz�
(2) 7 ��
(3)
(4) a 30
(s) - —
(6) 30
(7)
— O —
(8) �� 3 0
4-m4.4 I.iz" g d -rct
9730
- ACTION BY AUDITOR -
Assessed
Valuation
j�j
G — ft6ftD
o4� =rte -8'
32?aiV
,5 -- 7- 7.
Date
Homestead
Valuation
Date: - -62? 7 ,�9