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M HC 10 1979 To Be Filed in Duplicate
prescribed By State Board of Tax Commissioners -,: p e'I —90 3= o 0
CLAIM FOR UESTEAD PROPERTY TAX CREDIT FOR YEAR 19=
SEE BACK FOR FILIN INSTRUCTIONS
certify that on theist day of
March, 19 I, (i-K occupied as our principfal pl ce of residence the following described real
property for which a Homestead ?roperty.Tax Credit is hereby being claimed:::_;: .
I, (we) F] owned 9
are buyinq under contract
have a beneficial interest. in. the taxpayer ;'-
Property Description in County Township.
Taxing District - (City, Town, Township): Q n,
Parcel slumber or legal description shown on tax statement:
If buying on contract: owners name' (fee simple owner)
Contract recorded in Recorder's 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.: incase, - describe the use and portion of
the property utilized to produce, income
Any other counties in which- individual owns or is buying real Property - Co _ t i P
�4 r y
I herehy.certify the above statement is true, correct and Clete
*Signature .: :: Street Address City,:. state and _Zip Code
*Individual either owns or is buying uner a contract that provides he is to pay the
property taxes on the ..residence, or has a beneficial interest.. in. he..taxpayer.
- FOR ASSESSOR S USE ONLY• { :
True Cash Assessed .- ` Homstead
Value Valuation' Valuation
Land not exceeding 1 (one) acre immediately;
surrounding residential improvements (1) _ ' FD / % O
Dther Lana :.:' (2)
Total Land (3) / .� _ X_.�:..
Residential :Inprovements
Dwelling (4) ' 9��. -_' /
- Garage (5)
Total (6) 9 Zo`: k 990
Other improvements - (7)
Th.-4 Improvanents -Line (6) Plus (7) ernaals (B) (6) %y
Wrcertify the above is true, correct, arnd complete.
eby �v
A4- Date .. .
- ACTION BY AUDITOR -