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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
: ..y CREDIT /STANDARD DEDUCTION- HC10
State Form 5473 (R2/1 -90)
INSTRU&IONS: See reverse side for filing instructions. 9
CERTIFICATION STATEMENT �481AX —D0
I (We) � � /l le Q _ certify that on the '1 st day of March', 19
IIIIll occupied as our principal place of residence the following described real property for which a Homestead
Property Tax Credit is hereby claimed: E� l (We) owned El Are buying under contract
�Havpe r�° i al irg�re t i the entity that is liable for the property taxes on the property and that owns the
El roe o c era contract.-.:
MAY !'-tip CONTRACT RECORDED
I f buying on o� ntracI Fe Simr p owner's Name
S
Recorder's office vffMkm WMra6t .is recorded Record Number Page
PROPERTY DESCRIPTION
Taxing_District (City, town, township)
Parce Nu be Legal Description ��_� _r O /
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
lure is used to produce income.describe the use and portion of.the property utilizedto produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
ownship :�
Country
Township
hereby certify the above statemems'are true, correct and' - -
complete.
S, 2 natur o
� \
Address (Street, number, city, state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON -RESIDENTIAL
VALUE
Land not exceeding.V(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
of 112 Homestead
(2)
Lesser of 112 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
4-esser
1990 Pay 1991
1991 Pay 1992
19— Pay 19
of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 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 Signed-.-
-�
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