Homestead_Christmas (3)�• ^ ?a CLAIM FOR HOMESTEAD PRO FORM YEAR
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CREDIT /STANDARD DEDUCTION Hcto
' State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
5.0006I
CERTIFICATION STATEMENT
(We) 4' �u oex �x Q `-Lx'' •`'certify that on the 1st day of March -, 19 / C�
I (We) occupied as our principal place of residence the following described real property for which a Homestead
Property Tax Credit is hereby claimed: I (We) owned ❑ Are buying under contract
El 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. • _ //nn r /
�/ -•/ 7�� ' -ex 107 r5o' -�
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
P3 cel�umbe 3o / Legal ri- V S _ 3- / Z S-00 ac
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 incomedescribe the use and portion of the property utilized to produce income.
Il7o� /'117330R;
dk• AOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
�ounty --
Township
- County i
Township
I hereby certify the above statements are true. correct and -
Sign e •
complete.
Signature of Auditor / Dete Sipn%
(3)
Address (Street, number, city, state and ZIP code)
Rpm
_ V v 1.7JV
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
10 "ALUE-
Land not exceeding 1 (one) acre immediately
surrounding residential vmprovements
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
Lesser of 112 Homestead
Valuation or $1,500
19— Pay 19 —
Lesser of 1/2 Homestead
Valuation or $1,500
AUDITOR
(2)
Signature of Auditor / Dete Sipn%
(3)
(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
E.
Date Signed
�f
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
Lesser of 1/2 Homestead
Valuation or $2,500
1990 Pay 1991
Lesser of 112 Homestead
Valuation or $2,000
1991 Pay 1992
Lesser of 112 Homestead
Valuation or $1,500
19— Pay 19 —
Lesser of 1/2 Homestead
Valuation or $1,500
Signature of Auditor / Dete Sipn%