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., CLAIM FOR HOMESTEAD PROPERTY TAX
r �`f CREDIT /STANDARD DEDUCTION
Stale Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing irlstructio11s.
CERTIFICATION STATEMENT
FORM YEAR
I1c10
I (We) certify that on the 1st day of March, 1
I (We) occupied as our principal place of residence the following described real property for wilmAx 1 loore5fe[ad
�perly Tax Credit is hereby claimed: ❑ 1 (We) owned ❑ Are bovirrg under contract
rrr,
E] property a beneficial interest in the entity [flat is liable for the properly taxes on life property arioviflco Mir
property or is buying it under a contract.
CONTRACT RECORDED
11 buying on contract, Fee Simple Owner's Nanre
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
District (City, town,
Legal Description
V d — 0<1u ire any portion of the residential structure or the land not exceedin ne (1) acre that immediately surrounds that struc-
ture is used to produce incorne describe the use and portion of the property utilized to produce income.
aZ -/3- /7- J03 - -700, 2;7,7- e5lj-.S
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
rownsl rip
reby certify the above statements are true, correct and
oplete.
Signalur
Address (Street, number, city, stale and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) Through line (6)
Total value - line (3) plus lime (7)
(1)
1991 Pay 1992
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19
Lesser of 112 I lorneslead
Valuation or $1,500
(2)
Signature of Auditor
(3)
(4)
(5)
(6)
(7)
(8)
1 hereby certify lire above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANnAnn DEDUCTION ALLOWANCE
1989 Pay 1990
�esser of 112 Homestead
Valuation or $2,500
1990 Pay 1991
Lesser of 112 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19
Lesser of 112 I lorneslead
Valuation or $1,500
Signature of Auditor
Date Signed
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