HomeMy WebLinkAboutHomestead_DyballFORM HL 10 1979
hescrioe0 By State Boaro ot Tax Commissioners
� �iWO)�
�arch, 19�
which a Hom
u
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
crG aerk rn❑ �u in�r_
01� //-�4'
❑ are buying under contract
❑ have a beneficial in)eSjest in� the taxpayer
Property Description in ?� /-�— !�--��3-v
Taxing District (Eity,-�own_Township):�
Parcel Number -
If buying on contract: Owners
To Be FileA In Duplicate
�p$ -OOS� �
n,y��"'certify that on the 1st day of
the following described real property for
-�.�dG-aeZ/
Township
or legal description �Shown- on tax statement: _ _.
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
' Individual either owns or is buying under a coniract 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
T�otal Land � � � � �
Resitlential Improvements Dwelling
��„ tg�g
JU± '
Garage
/���`��Total
Other Improvements �� ' T R
Tn�-� �I,mprovements - Lin (6) plus (7) eq�al� (8)
I�,�Qy certi(y thG above is jrue. correct. and complete.
O� ASSM50�
True Cash
Value
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(2) �dg�-v
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(a)¢i�-5� 7 Q
- ACTION BY AUDITOR -
Assessed
Valuation
Homestead
Valuation
_ � 7— 79
oa:�
proved: �I . q' .��l�if� Date: 7�-} �