Homestead_Davis (15)FORM HC 10 1979
Rescribed By State Board of Tae Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1977
To Be Filed in Duplicate
11 SEE BACK FOR FILING INSTRUCTIONS EJe+� O03% 5
,;We) �, ll�- Q' S?$ "r 4e, certify that on the 1st day of
March, 19-7-Q I, (We) occupied as our principal pl atge of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) n owned �G- /O- ,36 - �O / -OOQ
❑ are buying under contract
❑ have a beneficial Aterest in the taxpayer
Property Description
Taxing District (City, -TowFr Township):
Parcel Number
If buying on contract: Owners name flee simple owner)
Township
ddc[� V
or legal description shown on tax statement:
I /
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:
�iereby certify the above statement is true, correct and complete.
13
6 -3 -79 _ street Address
C �c/ut
County Township
'J,Ike.,T
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 (one) acre immediately
surrounding residential improvements- -
Other Land
Total Land
Residential Improvemer N 51979
True Cash
Value
(1) /',? 2r0
(2)
(3)3370
Dwelling (4) 15, U O
/} Garage (5)
Total (s) A-6 D 2�' U
Other Improvements AUDITOR (7) °
J4 improvements - Line (6) plus (7) equals (8) (8) ton U
1 11 y certify the above is true, correct. and complete.
r" of Assessor
ACTION BY AUDITOR -
Approved
Assessed
Valuation
Homestead
Valuation
11
•s- �P- 7 9
Date