Homestead_Vore (2)n F, CLAIM HOMESTEAD PROPERTY TAX.
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for tiling instructions.
CERTIFICATION STATEMENT
FORM oYEAR
HC10 l
V0011'.'
. . .
h (We) X14 \h J� h �_ certify that on the 1st day of March , 19
I (We) occupied as our principaYplace of residence the following described real property for which a Homestead
`roperty Tax Credit is hereby claimed: ❑ I (We) owned ❑ Are buying under contract
EjHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
prop%qK.o1Li5_buyinq it under a contract.
CONTRACT RECORDED '
If buying on co tract. Fee Simple Owner's Name
l IV A, y 1990
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
County Township Tax' g.District (City, town, township)
arcel Nu r Legal Description
If any portion of the residential structure or the land not.exceeding one (1) acre thdtYnmediately 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
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-
iLesser 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
(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-
iLesser of 112 Homestead
Lesser of 112 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
Date Signe