HomeMy WebLinkAboutHomestead_OhningFORM HC 10 1979 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19Z?__
SEE BACK FOR FILING INSTRUCTIONS u01_ 0063Lt-0O
(We)� „1�� llJ� ��GMO- certify that on the 1st day of
arch, 19__;?�X 1, occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed: / L/
I, (We) ® owned
❑ are buying under contract
❑ have a beneficial int //ee//{{//ea�st in the taxpayer
Property Description in
Taxing District (%cy Town, Township):
Parcel Number
If buying on contract: Owners name f1ee 9np1B
� Township
or legal description shown on _tax statement: _
><
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 statement is true, correct and complete.
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) a irILFj D
surrounding residential improvements
Other Land JUt4 2 0 1979
Total Land
Residential Improvements eF. ,�,�
AGD ling
Garage
Total
Other Improvements
Tr Improvements Line (6) plus (7) equals (8)
I Oby certify the a is true. correct and complete.
Signature of Assessor
11
True Cash Assessed Homestead
Value Valuation Valuation
(1) S
60
(2) 7s0 o
(3) IF D O D
(4) /3 / Y B
(5) 'F'O
(6) _/ f� 5� ,' O
(7)
(s)
Date
ACTION BY AUDITOR -
Date: