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dr CLAIM FOR HOMESTEAD PROPERTY TAX
y _ CREDIT /STANDARD DEDUCTION V-
State Form 5473 (R2/1 -90) P
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEAR
HC10
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( _ _certify that on the 1 st day of March 19
I (We) occupied as our principal lace of residence the following described real property for which a Homestead
Property Tax Credit is hereby claimed: a 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
El pro RilQ or is buying it under a contract-
CONTRACT RECORDED
If buying on
Recorder's office where contract is recorded I Record Nuinbe "r I Page
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40 A AUDITOR PROPERTY DESCRIPTION
County Township I Taxing Di@tri t (City; town, township)
Legal Description
If any portion of the residential structure or the land not exceeding one. (1) acre that immedately 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
6,County I Township I County Township
I hereby certify the above statements are true. correct and
Address (Street. number. city, state
V
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acie immediately
surrounding residential improvements
Otherland
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 line (7)
(1)
1991 Pay 1992
19 —Pay 19—
Lesser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1.500
Valuation or $1,500
(4) - - -
• • -
- -- - -
- - — -
(5)
(6)
(7)
(8)
I hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
oil 1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19—
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1.500
Valuation or $1,500
Signature of Au r
l/1�
Date Signe -
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