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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R215 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10 LI& 90
I (We)� o�,Q„,� certify that on the 1 st day of March, 19-7 -�
II (W�ple as our princ al place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
r- I (We) owned ❑ Are buying under contract
-lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
- C_ ONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County _
Towns
Township
Taxing district (city. tq
n, township)
isess (number and street. dry, state. ZIP code)
I
Signatu o uditor
�-
Otherland
(2)
Parcel number
Legal de iphon
-bP-ra
(3)
-a- )? - 116 IZ-
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Residential improvements
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
isess (number and street. dry, state. 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.
(1)
Valuation or S2.000
Signatu o uditor
�-
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
_
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plis line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
r• STANDARD DEDUCTION ALLOWANCE
Ij 19 _Pay 19_
Lesser of 112 Homestead
$
Valuation or S2.000
Signatu o uditor
�-
Date signed
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