HomeMy WebLinkAboutHomestead_Doerner (5)P11.
(00i CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION State Form 5473 (R2/1 -90) INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEAR
HC10
7
001' 01la 3 $' o0
I (We) nrp � certify that on the 1st day of March , 19TjL)_
I (X \'sypied as our principal place of residence the following described real property for which a Homestead
Pro ®ty Tax Credit is hereby claimed: El (We) owned El Are buying under contract
Li 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
PROPERTY DESCRIPTION
County
Parcel Number
(City, town,
If any portion of the residential structure or the land not exceedinUne (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 Township County Township
I he,- certify the above statements are true, correct and bignature
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)
1991 Pay 1992
19 —Pay 19 —
Lesser of 1/2 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
Signature of Auditor
(5)
(6)
(7)
(8)
I hereby certify the above is true, Signature of Assesor
correct, and complete
Verifying Action - Signature of Auditor
Date Signed
Date Signed
nrAkMnon nCnIIr`_rInAl Al I r1WANCF
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19 —
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
iValuation or $2,000
Valuation or $1,500
Valuation or $1,500
Signature of Auditor
Date Si ned
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