Homestead_Dearing (3)FORM HC 10 1979
Prescribed By State Board out Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 F
M
To Be Filed in Duplicate
O0 3 -00 {0 (
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(We) certify that on the 1st day of
March, I, (We place of fesidence 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 County ° Township
Taxing District (£ity"Toavrr Township):
Parcel Number
If buying on contract: Owners name "c" Simple owner)
T7^ltC/1�U
or legal description
shown on
tax statement:
4,14 15�1
tiWv
Contract recorded in Recorders Office - Record No
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.
a - Street Address / City. State and Zip Cede
6�7/Ay
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 -
True Cash
Value
Land not exceeding 1 (one) acre immediately
surrounding residential iTILED (1) Other Land (2) - ° -
Total Land (3)
Residential Improvements
� % JUN 1979OwTellin2 (4) —�°� a O
e AUDITORTotal (6) a a CO
Other Improvements (7) °
To, I Improvements - Line (6) plus (7) equals (8) (8) a o
IFoy certify the above is true. correct. and complete.
of Assessot
- ACTION BY AUDITOR -
Assessed
Valuation
/7d
Homestead
Valuation
,-)`- 9- 79
Daze
Date: 6 P