Homestead_Winstead (2)FORM MC 10 1979
PrtSUi�eO By State Bodrd al ia� fAmmissfoners
To Be FiIM in Duplica�e
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 �� �19 �5
SEE BACK FOR FILING INSTRUCTIONS Q�
� (We)
�iarch, 19�2, I, (We) occupie
which a Homestead Property Tax
�� �� 'r �L�-�-�� K� � certify that on the 1st day of
ur principal place of residence the following described real property for
jit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial inte�est,in the taxpayer
Property Description
Taxing District (C-,}�y�ewa- Township): �"�'�x-
Parcel Number
If buying on contract: Owners name u� simo�e ow�en
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nty � Township
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or legal descnption shown on tax statement:
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Contract recorded in Recorders Office - Record No
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 naaress
County Township
City. Sta�e antl Zip
' Individual either owns or is b����g under a contract that provides he is to pay the properiy taxes
or� +ha re,s�r , or has a beneficial interest in the taxpayer.
�� ��---, l � FOR AS£�'�`R'S USE ONLY - —
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Land not ezc ding�t one) acre imr� /°I�
surrounding residential improvemP-
T�otal Land �� � � � �
Residentia� Improvements � Dwelling
,; � P! 2 ; 13%9
Garag�
� /�/��� . �Fotal
Other Improvements � � '��y
T�' � Improvements - Line 6) plus (7) �ua1�Q8�
I�by certify,the aboy.� is true. correct. and complete.
OI ASSPSSOt
Approved:
True Cash Assessed Homestead
Value Valuation Valuation
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- ACTION BY AUDITOR -
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Date: _ � - y 7—.�