Homestead_Timberlake°h CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
e <. FORM
� :CREDIT /STANDARD DEDUCTION - - Hc10
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
i" (We) �o Z,71�7B60e�AeLcertify that on the 1st day of March , 19
`rWe) occupied as our pri pal place o esidence the following described real property for which a Homestead
Property 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 Number Page
PROPERTY DESCRIPTION
County Q p p Tow iR Taxing ' try y, town, township)
Parcel Number o X03 Legal De = " 5
If any portion of the residential structure or the Ian not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce
ILE
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES II Inl n . innn
°hereby certify the above statements are true. correct and
complete.
Address (Street, number, city, state and 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
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)
(2)
(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
rv�
4"d9 Pay 1990
Lesser of 112 Homestead
Valuation or $2.500
STANDARD DEDUCTION ALLOWANCE
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
I' Signature of Audit f) ^ qy r'I I u (^e 4 —9 n