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CLAIM FOR HOMESTEAD PROPERTY TAX
- -� CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90) -
° ° INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEApR
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I (We certify that on the 'l st day of March , 19
`(We) occupied as our pri residence the full ing described real property for which a Homestead
//Property Tax Credit is hereby claim* cl. I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable foi the property taxes on thF1j a j tn� o�rns the
❑ property or is buying it under a contract. I
CONTRACT RECORD_ ED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record N Page
[=61;1 4:iyal] *61:11!kOO
ou , Township Taxing District ( own, to nship)
Parcel Number iS — Legal Description
00 _ 0 _b -o�
If any portion of the residential structure or the land not 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.
OZ> -
601 IZZ % 00/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County I Township I County I Township
hereby certify the above statements are true. correct and
Address (Street. number. city. state and ZIP code) 1 u
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 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1.500
Valuation or $1,500
(4)
- - - -
-
- -
(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—
Lesser of 1/2 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
Si at re�off Auditor
1 C v r -`-'
Date Date Signed
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01111111