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..•a��. CLA.IM FOR HOMESTEAD PROPERTY TAX
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;�'`°``� f? CREDIT/STANDARD DEDUCTION
�' � . State.Form 5473,(B2/1-90)
INSTRUCTIONS::See reverse side for filing instructions. .
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FORM � Y \
HC10
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• CERTIFICATION STATEMENT � �''�� �
I(We) � RX�YtJ�{� � I'tJ2�C1�i"L!�' ���y that on the 1st day o( Maroh , 19 �
I(We) occupied as our princiPal place of residence the following described real property for which a Homestead
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�erty Tax Credit is hereby`.claimed; .__. _ [� I(We) owned ❑ Are buying under contract
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� Have a beneficial intere�s4in the entity that is liable for the property taxes on the property and that owns the
property or is buying itj;under a contract.
ng on contract, Fee Simple� Owner's N
der's o(fice where contractlis recorded
CONTRACT RECORDED
PROPERTY DESCRIPTION
Taxing Di�hjc
Record Number Page
Parc I Number Legal Descri U n �
�J� -0000co-o0 i�a �'�- S/�- I�- a- in - 20�.
If any portion of the residential structure or the land noi exceeding one (t) acre that immediately surrounds that struc-
ture is used to produce income�describe the use and portion of the properiy utilized to produce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
� ASSESSOR USE ONLY � 1 TRUE TA7( VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL `.
VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements (� �
Olherland � (z)
Total land - line (1) plus line (2) ,; (3)
Resideniial improvements Dwelling (4)
Garage (5)
Other improvemenis (6)
Total improvements - 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 complete
Veritying Action - Signature o( Auditor Date Signed
1989 Pay 1990
,��ser of 1!2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pa 1991 1991 Pa 1992 19 — Pay 19 —
Y Y
j'Cesser of tl2.Homestead Lesser o( 1/2 Homestead Lesser of 1/2 Homestead
i;;,: Valuation or $2,000 Valuation or $7,500 Valuation or $7,500
Signature of Auditor i, �9 j�/;
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