HomeMy WebLinkAboutHomestead_HenagerFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 ;z�?
SEE BACK FOR FILLIINGe INSTRUCTIONS
(We) JIB ��e certify that on the ,1st da`y/of
arch, 199 ;Z: 4, (We occupied as our principal place of residence the following described real property for
Which a Homestead Property Tax Credit is hereby being - ,claimed: //
I, (We) jsrowned _�O - oy —lam — •'.3� /' aZ
❑ are buying under contract
❑ have a beneficial interest in the taxpayer �1
Property Description in -- - County COQ Township
Taxing District (efts -F~, Township): da_o_ +-rte
Parcel Number or legal description shown on tax statement:
Pt W 07, 3 9 7� Q �o
If buying on contract: Owners name (fee simple owner)
Contract recorded in Recorders Office - Record No. Page If any portion of the residential structure or the land, not exceeding one (1)racre 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.
oAu� 1�2 Z--/-?O fir, SL7�
Z 4Signalure • -r) A Street Address Qty: 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 F I L
Total Land
Residential Improvements Dwelling
JUN 2.) 59 %9
Garage
1K4_9_6& Total
Other Improvements / AUDITOR
_ T Improvements - Line (6) plus (7) equals (8)
I *by certify the above is true. correct. and complete.
of
True Cash Assessed Homestead
Value Valuation Valuation
(2)
(3) 3 s 0
(4) Xd
(5)
(6)
I 'O
(8) kw
aS11b
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370
s =9- 79
Dare
Date:
3