HomeMy WebLinkAboutHomestead_Davis (8)FORM TIC 10 1979
Presented By State Board at Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19L
To Be Filed in Duplicate
SEE BACK FOR FILING INSTRUCTIONS W5 �38�
` ®(We) t*-a--� ��`
the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) g owned gg 2 p
❑ are buying under contract
❑ have a beneficial interest in the taxpayer (L7
Property Description in County ^-�5Z Township
Taxing District +G41~ TeWr, Township): o
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name It- simole --act)
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:
hereby certify the above statement is true, correct and complete.
County Township
ure - Street Address O City. State and Zip Gave
/s /9 ?y
Individual either owns or is buying under a contract that provides he is to pay the property taxes
L')�7�residence, or has a beneficial interest in the taxpayer.
1�yJ LL - FOR ASSESSOR'S USE ONLY -
MAY 161979
Land nose g ediately
surrounding r enttal Irp�pyl3aRnts
Other Land
Total Land
Residential Improvements
Other Improvements
of
Owellin�
Garage
Total
rovements - Line (6) plus (7) equals (8)
certify the above-is-true. correct. and complete.
True Cash
Value
(1)
(2) — ° —
(3) � 4>O
(4) 771.0
(5)
—
(6) 77 i cZ
(7)
(a)774o
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
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1.5 -- 9- 79
Dare
Date: