Homestead_Wright (4)FORM HC 10 19�
Preuribed By Siare BoarO of ia. Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
io Be filea in Duplitate
SEE BACK FOR FILING INSTRUCTIONS ,��_S -�'q�p O
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�(We) w�� �-� �� ��-�-��*-�
I, (We)�5�iowned p�� ���7 /� -�/9�a�°°��
❑ are buying under contract
❑ have a beneficial interest in the taxpayer _
Property Description i
Taxing District (Si�y--�ewrr,-Township): �'v�y
Parcel Number
If buying O!1 contract: Owners name ��� simoie ownerl
1 � �-^° -i1 Township
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or legal description shown on tax statement:
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Contract recorded in Recorders Office - Record
If any portion of the residen[ial 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
�
�
��1
Screet naaress
County
Township
S
Ci�y, $lare ana 2ip CoCe
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 exceedingt��f on� acr imm�d�'ate[�
surrounding residenti�l impJove�,ey.nts � ��
Other Land
rotal �and JUN 4`� 1979_ ,
Residential Improveme /����� Dwelling
� Garage `�
� AUOITpF2 Totai
Other Improvements
Improvements - Line (6) plus (7) equals (8)
lyy certify the, above is true. correcl. and complete.
A5sC55or
Approve
True Cash
Value
(1) � o �
(2) —�
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�a � / 0 7 2,-0
cs>
cs� / 0 7 a o
(7) — ° —
(8) / O 7� C�
- ACTION BY AUDITOR -
Assessed Homesiead
Valuation Valuation
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