Homestead_Griffith (3)FORM HC 10 1479 To Be Filed in Duplicate
Prescribed By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 197�_' ✓
��// Q,SEE BACK FOR FILING INSTRUCTIONS O/6 - O °Yo $ -eoa
We) 7� 1z-.- / fV. `b 1�LuiLX., � , Ze certify that on the 1st day of
arch, 19-7-f--, I, (We) occupied as our principal place of resideIK49 the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) owned
❑ are buying under contract
❑ have a beneficial intost in the taxpayer
Property Description i
Township
Taxing District (City, Town, Township): v a r
Parcel Number or legal description shown on tax statement:
If buying on contract: Owners name (fee simple owner) Z • 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: County
�ereby certify the above statement is true, correct and complete.
Township
and Zip Code
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 -
FILED
Land not exceeding 1 (one) acre immediately
surrounding residential improvements JUN 51979
Other Land
Total Land
Residential Improvements
Other Improvements
/�
Ab' °flO 9
Garage
Total
(1)
(2)
(3)
(4)
(5)
(6)
(7)
TV"' Improvements - Line (6) plus (7) equals (8) (8)
1 ►boy certify the above is rte. correct. and complete.
Sgnature of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
ate- 79
Date
ACTIO BY AUDITOR -
Date: 117