Homestead_Pinnella., >F.
„ CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
t !' State Form 5473 (R2I 5-92)
16
INSTRUCTIONS: See reverse side for filing instructions.
F�
MAY 18 1999
/7 n
CERTIFICATION STATEMENT Li l(_
r1I IT ^`1
I (We) Ge�tBytfiat on the 1st d� oiMarch, 19_
I (We) occupied as our principal place of residenceAe following described real property for which a Homestead Property Tax Credit is hereby claimed:
IP'i(We) owned ❑ Are buying under contract
❑ 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 under a contract.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
_ PROPERTY DESCRIPTION
County
Township
Taxing disco (city town, township)
Parcel number
110 E97
Legal description
/0
If any portion of the residential structure or the [and not excee Ong one (1) acre that immediately sunouAds that structifte is used to pr duce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township - County Township
Si a of daimon r
Hereby certify the above statements are true, correct and complete.
Address (number and street, city, 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)
Other land
(2)
Total land (line I 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 plus line 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
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
5
Sig. t r f Auditor
.Q77
Date signed