Homestead_Witt (3)�. , „
CLAIM FOR HOMESTEAD PROPERTY TAX
dfA' CREDIT/STANDARD DEDUCTION
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� � State Form 5473 (R2/1-90)
�'°�• � INSTRUCTIONS: See reverse side for liling instructions.
CERTIFICATION STATEMENT
FORM
HC10
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I(We) �,(.� � �,� �.Q"1-�+�CZ �_ • W.(iU certify that on the 1st day of March , 19 /( J
�'�We) occupied as our principal place of residence the fo ng described real property for which a Homestead
Yroperty 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 ihe property and that owns the
property or is buying it vnder a contract.
buying on contracL
Recorder's office
CONTRACT RECORDED
Name
contract is recorded
ownship
.�I�/UL,O
PROPERTY
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I( any portion of the residential struciure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion oi the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
ceriify the above statements are true. correct and � Signat� �� J /
/�
� (S�eei,�� ber. �ty, sta�e� Z��e) o � � I : $�
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ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE
NON•RESIDENTIAL
VALUE
Land not exceeding 1(one) acre immediately
surrounding residential impwvements (�)
Otherland (2)
Total land - line (7) plus line (2) (3)
Residential improvements Dwelling (4)
Garage (5)
Other improvemenis (6)
Total improvements - line (4) through line (6) (7)
Total value - line (3) plus line p) (8)
I hereby certiiy the above is true, Signature oi Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
' Lesser ot 1/2 Homestead
Valuation or $2,500
SignaWre of�itor
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991 I 1991 Pay 1992 I 19 _ Pay 19—
Lesser of i/2 Homestead Lesser of t/2 Homestead Lesser of t/2 Homestead
Valuation or $2,000 Valuation or $1,500 Valuation or 31,500
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