Homestead_Douglas (8)FORM HC 10 19i9 TO Be FileG in Ouplicate
PrewiOea By Sta�e Boam o� Ta. Commissianers
CLAIM FOR HOMESTEAD PROPERTY TAX CREOIT FOR YEAR 19 7 y
SEE BACK FOR FILING INSTRUCTIONS �QS � 00�7�
��We)_/t5./��-� L%t�l�«1/ -� • •��+—!-e,e� � certify that on the 1st day of
rch, 19�Y, (We) occupied as our p cipal place of residence the fotlowing 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
Taxing District (Gii�r;-�ew+i, Township): V��
Parcel Number
If buying on contract: Owners name "� "'"o'e °""e"
c�G-/d�,D �%/J.3 - OQO. �f/_� ��/
/��2-, u� Township
or legal description shown on tax statement:
� S c.J 'v -7- 3 // s °�---�
� . .
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (7) 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:
certify the above statement is true, correct and complete.
��,�.��
County
Township
� ,�
Individual either owns or is buying under a contract that p�ovides 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 � Q
Residential improdements . _ .`r��y
J 1 "J _
`:' �' ` Garage
/��� f� Total
Other Improvements � � f p�p�iOR
v�. �
7n�°' Improvements - Lm (6) plus p) equals (8)
I.�.iy ceriify the above is true. correct. and comp�ete.
Dwelling
A5525SOI
True Cash
Value
( � ) 5_Ca2—
(2) �_(p0
(3) % � � O
(4) ���'`�
(5) - o —
(61�4
(�l�/O
ce� /6 8' s'o
- ACTION BY AUDITOR -
Assessed Homestead
Valuation Valuation
/ 7 U
:
/70
�
���s.,
�-/�-�9
DaiC
Approved: Date: