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State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEAR
HC10 {�
a
I (We) _ certify that on the 1st day of March , 19 / V
kWe) occupied as our principal place of residence �Me) wing described real property for which a Homestead
roperty Tax Credit is hereby claimed: 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 it under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded
Record Numb'
Township
Wesser of 112 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
PROPERTY DESCRIPTION
County
ownship
Taxing D' trict (Ci y, town, to ' ship)
(4)
Parcel NumAPR
Legal Description rit (2,
2
If any portion of the residential structure or the land not exceeding one (1) acre that immediately at struc-
ture i rho describe the use and portion of the property utilized to produce income.
AUDffM
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Townshi
County
Township
Wesser of 112 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
hereby certify the above statements are true. correct and
complete.
Signature
Address (Street, number, city, state and ZIP code)
LAdD %DO �
ASSESSOR USE ONLY
Y,m? 130 nl k
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
19— Pay 19 -
Wesser of 112 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
Signature of Auditor
1�
(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 -
Wesser of 112 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
Signature of Auditor
1�
Date Signed ,
Li-9(0- v