Homestead_Wellsr
da, CLAIM FOR HOMESTEAD PROPERTY Y TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
,INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
v H C10
F I YY �h. E V
I (We) certify that on the 1 stmwopm%,iefi ; 19 q1
I
I (We) occupied as our principal place of residence the following described real pr rty for hic�, a Homestead
Property Tax Credit is hereby claimed: Ly/1 (We) owned Are Wder contract
El 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 Township Ta g District -(City, tbwn, township) -
P r e1Number 4S� "� Legal Description
If any portion of the residential structure or the land not exceeding one o) 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
BY CLAIMANT IN OTHER COU
JI hereby certify the above statements are, true, correct and Signature /Zrj GCI
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
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)
(2)
(3)
(4) - - - - -
– - -- - - --
- - - ---
- -- -
(5)
(6)
(7)
(8)
I hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
1989 Pay 1990
Lesser of 1%2 Homestead
V aluahon or $2,500
of AU6101
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser of 1/2 Homestead
Valuation or $2,000
WA
1991 Pay 1992
Lesser of 112 Homestead
Valuation or $1,500
19 —Pay 19—
Lesser of 112 Homestead
Valuation or $1,500
Date Sigr
5 -3-