Homestead_Creek (4)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19Z
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!�(We) /•� certify that on the 1st day of
March, 19�, I, (We) our principal place of re4dence the following described real property for
which a Homestead Property Tax Credit is ,hereby being claimed: 0
MM X3 .
I, (We) owned C D5 • C
11 are buying under contract �7 - � - Dao•�,.�d'- Q�
❑ have a beneficial intprest in the taxpayer
Property Description inL_� County Township
Taxing District Tr�a,�To.., , Township):
Parcel Number j or leg d sc ption shower on iPx statement
r
/ / -lJ_S<_r y /7 -a
If buying on contract: Owners name tree simple owner) <
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.
'Signature' s:reer Pdor¢55 City. stare 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 (one) elm edia�y D
surrounding residential impr m t �,j
Other Land
Total Land
Residential Improvements
MAY 181979
w Iling
i
AUDITC&rage4—
Other Improvements
1®�
Improvements - Line (6) plus (7) equals (8)
V certify the above is true, correct. and complete.
True Cash
Value
(1) - _1� 6TH
(2) to C'�
(3) / 6.0
(4)
(5)
(6)
(7) 70D
(8) ...3Z 30•
ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
/7
=e -7
Date
Approved: //1 l ^L Date: