Homestead_UppencampI
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
I (We) at on the 1st day of March , 1941
I (We) occupied as our rincipal place of resid c the fol ing describedreal property for which a Homestead
Property 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 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 Adco kjjujMjVage
PROPERTY DESCRIPTION MAY 0 9 1991
ownship
7 U J .:/
If any portion of the residential structure floe I d no 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 income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Townshi
County
iip
Lesser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 1/2 Homestead
I hereby certify the above statements are true. correct and
complete.
Sign re
Address (Street, number. it state and ZIP code)
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- - -
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Otherland
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—
Lesser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1.500
Valuation or $1,500
(4) —
-
Signature f Auditor
(5)
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(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
1
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19— Pay 19—
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2.000
Valuation or $1.500
Valuation or $1,500
Signature f Auditor
Date Signed
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