Homestead_Dearing (5)FORM TIC 10 1979
Prescribed By Slate Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 197�?
SEE BACK FOR FILING INSTRUCTIONS
To Be Filed in Duplicate
005- 00q 0 `{
.(We) �- `� certify that on the 1st day of
March, 19�_�_, I, (We) o upied as our pr cipal place of residence 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.int rest in' the taxpayer
Property Description in �^c-.�> �County �� {�hm�� Township
Taxing District (Gity- Tevvrr, Township): e &2=2
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners
's ,= !/y N ?-)
Contract recorded in Recorders Office - Record
/5-3- r/ X37
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 Street Adarefs City. Slate and Zip Coon
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 Assessed Homestead
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately l
surrounding residential improvements (1) S cry
Other Land FILE � (2) 15 �
Total Land (3) / D Z) o
Residential Improvements JUN (4) �S O
J 2 � 1979 g
Garage (5>
Total (6) — d
Other Improvements AUDITOR (7) 0
Tr' Improvements - Line (6) plus (7) equals (8) (8) 9 d 9940
I'Woy certify'the above is true. correct. and complete.
ionaA,c of Assessor
Approved
5-- 9- 7
Dare
- ACTION BY AUDITOR -
l/�1 a��4 Date: lzgb