Homestead_BeloatCLAIM FOR HOMESTEAD -PROPERTY TAX FORM YEAR
a CREDIT /STANDARD DEDUCTION HC to
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions -
CERTIFICATION STATEMENT ° o^
I (We) _% certify that on th 1 st day,gf fV�grp- F}°��19
a
11 (We) occupie s our principal place of residence thhe, following described real �CCTT G 'Homestead
Property Tax Credit is hereby claimed: f� 1 (We) owned ❑ Are buying under contract
L1 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
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
Township
PROPERTY DESCRIPTION
Taxing District
1?6ge1�11 ft-7 _� Legal Description P — a
��77 5 r
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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Y
I
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)
-
- -
(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 1 990
1990 Pay 1991
1991 Pay 1992
19— Pay 19
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1.500
Valuation or $1,500 ;
Signature of Audit
D3 Si nod
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