Homestead_Cope-14
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION C110-1 -�
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
MACERTIFICATION STATEMENT nt=C 47991
I (We) __ �rtify that on the/f5t dav,00#Td(�n
`we) ccc led as our principal place residence thh fff Ilowing described real property #MWci Homestead
Property T c L!d 1 (We) owned ❑ Are buying under contract
ave a beneficial interest in the entity that is la taxes on the property and that owns the
propy or is buying it under a contracty� `'
7 Qe/tJ (_ /v 17' RECORDED y��L
If b uyind on contract. Fe Simple Owner's Name MAY 10 1991
Re er's office where contract is recorded Number I Page
PROPERTY DESCRIPTION
County Township Taxing District (City town township)
PecVumber n_� Legal Descripti )n
If any (portion of the residential structure or the land not ex ding one (� 1)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 I Township I County I Township
certify the above statements are true, correct and
Address (Street. number. city. state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE
a
NON -RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
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 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
-(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
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 112 Homestead
Valuation or $2,500
Valuation or $2.000
Valuation or $1,500
Valuation or $1,500
Signature of Af.4itor Date Signed
_
7M
a