Homestead_Lane1_
CLAIM FOR HOMESTEAD PROPERTY TAX
4 CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
rFRTIFIrATION STATFMFNT
FORM YE R
HC10
I (We) f,, U-_) certify that on the 1 st day of March , 19 l
I (We) occupied as our principal place of residence the follo i g described real property for which a Homestead
®operty Tax Credit is hereby claimed: I (We) owned ❑ Are buying under contract
El property a beneficial interest in the entity that is liable for the property taxes on the property andthal owns the
properly or is buying it under a contract.
CONTRACT RECORDED :1
If buying on contract, Fee Simple Owner's Name
Recorder's office where contract is recorded Rec6 d;Number Page
PROPERTY DESCRIPTION
County A Township I Taxing Dislric
ar I fAu b r Legal Description
33-0 0 a -A_ S
If any portion of the residential structure or the land not exceeding one (1) acre that immqbiVtely sbiro4fids lVat struc-
ture is used to produce income describe the use and portion of the properly utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County T
Towns ' o
ou
19 —Pay 19-
Lesser of 112 Homestead
Valuation or $1,500
ereby certify the above statements are true, correct and r
rgn
mplete.
Address (Street number, city, Mate and code) N
N
ASSESSOR USE ONLY
K R ;5
TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE 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
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19-
Lesser of 112 Homestead
Valuation or $1,500
(2)
Signatur o uditor
(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
RTANnARn nFnucTION ALLOWANCE
1989 Pay 1990
�esser of 112 Homestead
Valuation or $2,500
1990 Pay 1991
Lesser of 1/2 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 1/2 Homestead
Valuation or $1,500
19 —Pay 19-
Lesser of 112 Homestead
Valuation or $1,500
Signatur o uditor
to Si/�ne
– to
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