HomeMy WebLinkAboutHomestead_Toth (3)fORM HC 10 1919
HescribeG By State Baard af Tax Commissioners
To & FiIM in Duv�kate
CLAIM FOR HOMESTEAD PAOPEATY TAX CREDIT FOH YEAR 19� -
SEE BACK FOR FILING INSTRUCTIONS Q� - ��$O3
�(We) �y�����°`' � ' ����V �c�ertfy that on the 1st day ot
�� arch, 19�2, I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: n
�, (we� ❑ awned pX� �O -�7 �OQ _ 11�J� d'�3- Q�-'/
❑ are. buying. under contract
❑ have a beneficial inter st in the taxpayer
Praperty Description in County -!^- a-�'�.-<o�,�l �Township
Taxing District (CiLy-�e+wt, Township):
Parcel Number or legal description.shown on tax statement:
s� � �lJw � i� 3-�i 7, y�a
If buying on contract: Owners name �'� ""'we ow�e�r �
Contract recorded in Recorders Oftice - Record
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.
County Township
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneticial 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 �
T '�' Improvements - Line (6)`
I�Dy certify the above is,
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us (7) equ�I(�
�ue. correct. and �nplete.
.s�3�7 9
True Cash Assessed Homestead
Value Valuation Valuation
(1) SO c�
(2) � �o d -
(3) / 2 l0 0
(41 0� D.�rro
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�g) o� o �-a-t�
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�8� / / .S�l�
- ACTION BY AUDITOR -
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S—� �-�G�
Dare
Date: �� �