HomeMy WebLinkAboutHomestead_Kohlmeier (2)FORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board al Ta. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19-2J-' D `
SEE BACK FOR FILING INSTRUCTIONS
(We) �"� a rrr Irv% certify that on the 1st day of
.larch, 19--Z7-- I, (We) occupied as our princi I place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: /
I, (We) 29 owned �Q
❑ are buying under contract
❑ have a beneficial interest jp the taxpayer
Property Description
Taxing District (Eitr, T-swa, Township): 10<9�
Parcel Number
If buying on contract: Owners name "" simple owner)
or legal description shown on tax statement:
Pt. S'C y // -.9 -5 79 y3 Qum
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.
Street Address
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
Total Land F L
Residential Improvements Dwelling
UN 1 3 1979 Garage
� Total
Other Impro, gts r�
To}nt- ,Improveme Line (6) 1�II�17URequals (8)
I &y certify the above is true. correct. and complete.
Assessor
True Cash Assessed
Value Valuation
- ACTION BY AUDITOR_:
Date
rrWIIII
f
Homestead
Valuation
Approved: f iii �+��t! Date: _lt"/ g -757