Homestead_ClineI
•�� CLAIM FOR HOMESTEAD PROPERTY TAX
d� a
y CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for tiling instructions.
CERTIFICATION STATEMENT
FORM AR
HC10
(We) j � W ,- ertify that*on the 1st day of March , 19
,We) occupied as our principal place of residence the followin described real property for which a Homestead
Property Tax Credit is hereby claimed: (We) owned. ❑ A u er ontract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the p el the
property or- is buying it under a.contract
rVIAy lul.9
GUNiHAGi HEGUHUtU
If buying on contract, Fee Simple Owner's Name
axwU &
Recorder's office where contract is recorded
Record Num er
Page
Township
D0l10G0Tv n=cPDIDTIn KI
Taxing
31 ro - 0()IX� -0 a i -cZ Vex y�,uur -, c� . i nn� yay . �
If any portion of the residential structure or the land not exceeding one-(1) ac that immedi tely s rrou s that struc- ,
lure is used to produce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
ounty
Township
County
Township
I hereby certify the above statements are true. correct and
m ture —ZJ
complete.
�i(�- -s--
ddres�(S7�tre t. pumper, c'ty, state and ZIP _ L , 1 r6 60-0235
ASSESSOR USE ONLY ' TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
II VALUE
Land not exceeding 1 (one) acre 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 112 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
Signature of Au "r
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19— Pay .19 —
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
Signature of Au "r
Date Sin d
- 90