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..f •T•y, CLAIM FOR HOMESTEAD PROPERTY. TAX
d � ` CREDIT/STANDARD DEDUCTION
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.� State Form 5473 (R2/t-90)
�' '°�° � INSTRUCTIONS: See reverse side for liling instructions.
CERTIFICA,TION STATEMENT
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on the.1 st
FORM YEAR
HC10 p�
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1
((We) occupied a�/our F(�yhcipal place of residence the fo lowing described real property for wfii�T���ad
Property Tax Credit is hereby claimed: .. I(We) owned ❑ Are buying under contract
� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract.
£ONTRACT RECORDED
on coniract. Fee Simple Owner's Name .
Recorder's office where contract is recorded
PROPERTY DESCRIPTION
County
Record Number
town,
Page
P�r�e,IDNurg¢��p/__l1�1 I Legal Description � f� ��_a `/0 �• 3Q dlC
/��X�� lJ 0(0 CiC/ r'_/
any portion of the residential siructure or the land not exceeding one ( t) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of ihe property utilized to produce income.
County
PROPERTY OWNED BY CLAIMANT IN OTHER COU
Township County
hereby certify the above statements are true. correct and I Signature
Address
ASSESSOR USE ONLY
state and ZIP code)
TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding 7(one) acre immediately
surrounding resideniial improvements (�)
Oiherland (2)
Total land - line (1) plus line (2) (3)
Fesidential�improvements Dwelling (4) - -
Garage (5)
Other improvements (6)
Total improvemenis - line (4) ihrough line (6) (7)
Total value - line (3) plus line (7) (8)
I hereby certify the above is true, Signature of Assesor Date Signed
correct, and comptete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
Lesser of t/2 Homestead
Valuation or $2,500
Signature of Auditor
STANDARD DEDUCTION ALLOWANCE
7 990 Pay 1991
Lesser of 1/2 Homestead
Valuation or �2,000
7991 Pay 1992 19—Pay 19—
Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or S7.500 Valuation or 57,500
Date Signed
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