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,._���.� CLAIM FOR FIOMESTEAD PROPERTY TAX
Cd �.F °�
,� I ��} CREDIT/STANDARD DEDUCTION
���� Slale Form 5A73 (Fi2/1-90)
INSTRUCTIONS: See reverse side lor lili ig inslrudions.
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(�Q.�p.r� �.G, � F1anl,C�.GERTIPICA710N STATEMENT
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I (We)
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Ihat on Ihe 1s1 day
Y 6 199?.
I(We) occupied as our principal place ol residence Uie tollowiny described real properiy lor wliich a I lomeslead
�'roperly Tax Credit is hereby claimed: �e) owned ❑ �re buying under conlracl
� Flave a benelicial inleresl in lhe enlily Ihat is liable for the property laxes on Ihe properly and tlial owns Ihe
prope�ly or is buying il under a coniracl.
on conlracl,
contracl
Townsl
CONTRACT RECORDED
PROPERTY DESCF�IPTION
fiecord Number
lown,
Paye
Panl� umO,��91 I Legal Desciiplion \) �f /� � � ���
�� �D V.a(.d�
II any porlion ol the residenlial slructure or Ihe land not exceeding one (1) acre Ihal inmiedialely surrounds Ihal slruc-
lure is used to produce income describe Ihe use and portion ol Ihe property ulilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTfiER COUNTIES
ASSESSOR USE ONLY TRUE TA% VALUE ASSESSED VAIUE t10MESTEAD VALUE NON-RESIDENIIAL
VAIUE
Land nol exceeding 1(one) acre immedialely
surwunding residenlial impwvemenls ( � 1
Otlier land (2)
Tolal land • line (1) plus line (2) (3)
ftesidenlial improvements Dwelling (A)
Garage (5)
Other improvements �6)
Tolal improvemenls - line (4) Ihrough line (6) (7)
Tolal value - line (3) plus line (7) (8)
I hereby ceitily ihe above is true, SignaWre ol Assesor Dale Siyned
correcl, and complele
Verilying Action - Signalure ol Audibr �ate Signed
1989 Pay 1990
;ser ol 1/2 Flomeslead
Valualion or $2,500
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Signalure ol Audifor
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser ol 1/2 1lomeslead
Valualion or $2,000
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1991 Pay 1992 19—Pay 19—
lesser ol t/2 Homestead Lesser ol t/2 Homeslead
Valualion or $1,500 Valuaiion or $1,500
Dale Signei
S -(o -9