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�• •, CLAIM FOR HOMESTEAD PROPERTY TAX- -
��•y : CREDIT/STANDARD DEDUCTION , �
��' State Form 5473 (R2/1-90) � "
'°" INSTRUCTIONS: See reverse side lor liling instructions.
CERTIFICATION STATEMENT
FORM YEAR
0
OCT 11 1gg1
c �
I I(We) __ � . l���c�.�. certify that on th� .�(,nR ,�9 �
��+(We) occupied as our principal place of residence �the, /following described real prop�ert�o�r �wfT�iCh a�Homestead
I Property Tax Credit is hereby.claimed: t/J I(We) owned ❑ Are buying under contract
�Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract.
CONTRACT RECORDED
If buying on contracl. Fee
contract
PROP.ERTY DESCRIPTION
Township � Taxing District
Legal Description
Record
If any portion of the residential siructure or the land not e c�, eding 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Townsh��= County TownssJ�
hereby certify the above statements are irue. correct and
Address (Street, number„city, siate and
ASSESSOR USE ONLY � � TRUE TAX VALUE� ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
' - ' VALUE
Land not exceeding t(one) acre immediately
surrounding residential improvemenis (�)
Other land . (2)
Total land - line (7 ) plus line (2) (3)
Residential improvemenis - Dwelling - � � (4) � � - � -
Garage (5)
Olher improvements (6)
Total improvements - line (4) through line (6) (7)
Total value - line (3) plus line (7) (8)
1 hereby certify the above is true, Signature of Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Dale Signed
1989 Pay 1990
Lesser of t/2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser of 1/2 Homestead
Valuation or $2.000
I �—
Signature of Auditor ,n � _
1991 Pay 1992 19 — Pay 19 —
Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or $1,500 Valuation or $7,500