HomeMy WebLinkAboutHomestead_HillenbrandFORM HC 10 1979
_ P(euri�eC By Siate BoarO of ia� Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19_Z�
�larch; 19_Y_�, I, I
which a Homestead
io Be FileG in Ouplicate
DO� �Of�S/ fJ
/ °✓ ertify that on the 1st day of
Ve) occupi d s our principal ace of residence the following described real property for
Property Tax Credit is hereby being claimed:
�, (we) � owned G��a _ o�� _/�-��� — �6�. ��— Qp� l'
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in � County Township
Texing District (Git�q-Tawrr Townshipl� ,
Parcel Number
If buying Ofl contract: Owners name ��� simo�e owner�
or legal description shown on tax statement:
,Q,: �'Y /(/GtJ�SL /P- 5�-/ O 9, /5 tt,c.cta�
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Contract recorded in Recorders Office - Record No. Page
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:
certify the above statement is true, correct and complete.
County Township
✓' - Scr3et Atlareu ' /\�/�� � G�ly. SJ�ta1P aM/ �Lp JC�oae6
�."�' / / / � / /
Individual either owns or is buying under a contract that provides he is t�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) acre immediately
surrounding residential improvements
Other Land � �
Total Land
Residential Im �vemen s Dwelling
JUW 12 t919 �a ar ge
Total
Other Impro�t � AUDITOR
To' Improveme - Line (6) plus (7) equals (8)
I�by �fy the above is true. correct. and complete.
Signa:ure of
True Cash
Value
� � ) s-o 0
(2) / 5� 7 a
(3) � � � o
(4) /U' /�L O
(5) —
(6) J d � � a
(�) '�
(g) / v /5L o
- ACTION BY AUDITOR -
Approved: /� •��c �C�1fz��eli�
Assessed Homestead
Valuation Valuation
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Date: f��-- 7 p