HomeMy WebLinkAboutHomestead_BuckmanFOFM HC 10 1979 To Be fileE in Uuplicate
PrescriDeC By Sute BoarO of iaz Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAA 19_�
SEE BACK FOR FILING INSTRUCTIONS .
��We) �+ S`� �����1�- Q �-�'-��M-Q� certify that on the tst day of
arch, 1�1, (We) 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) C�'owned D�/_ - Q[�a3�
❑ are buying under contract ��
❑ have a beneficial interest in the taxpayer
Property Description in �ti County `�a-�Q- Township
Taxing District (City, Town, Township): `��� �
Parcel Number or legal description shown on tax statement:
- �.x..d,�1 `Qc[�.4z� f,� ,�J G. V{- ai�d-t � . 3� 7�
If buying on contract: Owners name �'� "'"o'°
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:
�hereby. certify the above statement is true, correct and complete.
County Township
U
re n Street noaress ciry. Sta�e ana Zio �e
~ �� ✓ �-'
' 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) acre immediately
surrounding res�tia� improvements
Other Land � � �
Total Land
Residential Improvem��ts� � 5 )979
�l , , �p�
Dwelling
Garage
Total
Other Improvemen AUDITOR
To��' Improvements - Line (6) plus (7) equals (8)
I�Jy certify the above is irue. correct. and complete.
Signamre oi
True Cash
Value
(1) /'ioo
(2) �
(3) /700
(4) /GU3o
(5) —
(6)_�6030
(�) —
(g� !leo3o
�TN�[�l�t:l'I_��J
�
Assessed
Valuation
r
.
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Da:e
Homestead
Valuation
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Date: [� -��� / �