Homestead_ConderCLAIM FOR HOMESTEAD PROPERTY-TAX FORM YEAR
CREDIT /STANDARD DEDUCTION �.
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT I
f (We) certify that on th 1 s P
I (We) occupied as o r principal place of residence the following described real propert f l�d�PPh�a Homestead
Property Tax Credit is hereby claimed:I (We) owned - ❑ Are buying under contract
E] 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 contract. Fee Simple Owner's Name
Recorder's office where contract'is recorded Record Number Page
PROPERTY DESCRIPTION
County' Township n, C4. Taxing l tr,c ty, town, township)
Parcel Number O Legal s 'lion I UI + Is
If any portion of the residential structure or theUand not exceedi6g 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
k_1 ounty —_ Township. County Township
I heieby certify the above statements are true, . correct and Signature
Address (Street, number, city, state and ZIP code) /
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON -RESIDENTIAL
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
Lesser of 112 Homestead
Valuation or $1,500
19 —Pay 19
Lesser of 1/2 Homestead
Valuation or $1,500
(2)
Signature of Auditor (�
RJ,
(3)
(4)- -
(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
Lesser of 112 Homestead
Valuation or $2.500
1990 Pay 1991
Lesser of 112 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 112 Homestead
Valuation or $1,500
19 —Pay 19
Lesser of 1/2 Homestead
Valuation or $1,500
Signature of Auditor (�
RJ,
Date Signed
0141