HomeMy WebLinkAboutHomestead_Hornby (3)FORM HC 10 1979
Prenritied By State Board of Tax Commissioners
To Be Filed in 0uplinfe
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 7 2
pO/- 0o3�/ -0�0
SEE BACK FOR FILING INSTRUCTIONS J/
RWe) certify that on the 1st day of
arch, 19'% I, (e) o==incipkI placf residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) L� owned O?ro a ��— /�/`� !��` " .3011
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in c'14 w County Township
Taxing District (£ity- -P~, Township):
Parcel Number or legal description shown on tax statement: -
/ /
If. buying on contract: Owners
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: County Township
I hereby certify the above statement is true, correct and complete.
0
_ SignaNre _ Streg caress City, Yate and! Zip Cote
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
Total Land
Residential Improvements
Other Improvements
(1)
(2)
(3)
Dwelling (4)
True Cash Assessed Homestead
Value Valuation Valuation
Garage (5)
Total (6) — 6
(7)
mprovements - Line (6) plus (7) equals (8) (8)
ly certify the above is true. correct, and complete.
of AxS ssot
Approved
Date: