Homestead_Moore (4)FORM HC 10 1979
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR -19 7
To Be Filed in Duplicate
SEE BACK FOR FILING I TRUCTIONS Oil oOs��,Oo
certify that on the 1st day of
March, 19_ _, I, ( e) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned
;6are buying under contract !2
❑ have a beneficial interest in then taxpayer
Property Description in ru ZnL County Township
Taxing District T~, Township):
Parcel Number
If buying on contract: Owners name 'tee simple ..no,)
or legal description shown on tax statement:
oZ �-
Pt. ru,=i 5 Ey el- 3 -01' _4 1.
Contract recorded in Recorders Office - 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: County Township
hereby certify the above
®��1
staattjeement is true, correct and
''L -o�� f3d-.K X03
complete.
�sf 3
Signature
Street Address
City. State and Zip
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 -
True Cash Assessed
Value Valuation
Land not exceeding 1 (one) acre immediately
surrounding residential improvements (1) Soo /70
Other Land ( 2) (2) V_ao-40 —,a
Total Land @i (3) /- �St3Se�-�TV -o— %1yo
Residential Improvements c, Dwelling (4) 3 !ob'o
�'i.':` (5) %O
(6) -0
/ c
Other Improvements AUDITOR (y)
" Improvements Line (6) pf1us (7) equals (8) (8) .30c, tea'
To
certify the above is true. correct. and complete.
Assessor
- ACTION BY AUDITOR -
,5--/ S- 75
Date
Homestead
Valuation
Date: 4 —29. % 9