HomeMy WebLinkAboutHomestead_HillFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 1922
oci—o o 3527 -oo
// // !! // fJ SEE BACK FOP, FILING INSTRUCTIONS
(we) � °!�."`tQ� y certify that on the lst day of
March, 191, I, (we) occupied as our principa place of residence the following described real property for
which a Homestead Property -Tax Credit is hereby being 'claimed:
1. (we) 80wned
❑ are buying under contract
❑ have a beneficial interestes the ta er
Property Description in County
Taxing District (City- Towrr, Township): e5
Parcel Number or legal description shown on tax statement:
Township
If buying on contract: Owners name "" Simple owner)
Contract recorded in Recorders Office - Record No. Page
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.
Street Address
County Township
Coy. State ana Zip Cone
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 yP E
Total Land p�9
Residential Improvements .i Dwelling
JL 3 � 7979
Garage
Total
Other Improvements AUDITOR
O'T Improvements - Line (6) plus (7) equals (8)
by certify the above is true. correct. and complete.
True Cash
Value
(1) 3 0 0
(2)
(3) -:5 &d�7
(4) oV o2lP
(s) 0Z / D O
(6) & /v O
(g) (0 3 !o 0
Assessed Homestead
Valuation Valuation
o
jjjjj
ore of assessor Date
- ACTION BY AUDITOR -
Date: 7A 7V