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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION .
State Form 5473 (R2/1-90) �
INSTRUCTIONS: See reverse side for liling instructions.
CERTIFICATION STATEMENT
- 9�_g� _
FORM YEAR
HC10
that on
' � _
I(We) occupied as our principal piace of residence the fo owing described real propefty�or v�hi�Homestead
IVU
�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 �.p�ape�"y�towns the
property or is buying it under a contract. ;�UDI
CONTRACT RECORDED
on contracL Fee Simple Owner's Name
Recorder's office where contract is recorded
County
PROPERTY DESCRIPTION
Legal Descripiion
Taxing District (City, town, township)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPFRTV nWNED 8V CLAIMANT IN �THER COUNTIES
��`
ounty Township County Township
I hereby certify the above statements are true. correct and Signature
complete.
Address (Streei. number. city, state and ZIP code)
ASSESSOR USE ONLY � TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding 7(one) acre immediately
surrounding resideniial improvements l� 1
Otherland (2)
Total land - line (1) plus line (2) (3)
� Residential improvemenis Dwelling (4) � - - -
Garage (5)
O[her improvements (6)
Total improvemenis - line (4) through 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 complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
Lesser of 7/2 Homestead
Valuation or $2,500
Signature of Auditor
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser of 7/2 Homestead
Valuation or 52.000
1997 Pay 7992 19—Pay 19—
Lesser of 7/2 Homestead Lesser of 1/2 Homestead
Valuation or 57,500 Valuation or 51,500
Date Signed _