Homestead_Clevenger•r^ CLAIM FOR HOMESTEAD PROPERTY TAX
y CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
P. - -o0
FORM. �j YEAR
HC10 �-li�
I (WeL / O.hQrJ ertify that on the 1 st day of March , 19 �0
I (We) occupied as our principal place of residence the Poll ing described real property for which a Homestead
Property Tax Credit is hereby claimed: I (We) owned El Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the pro ert and that owns the
El property or is buying it under a contract. taff 16q
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name MAY I U 1991
Recorder's office where contract is recorded- filecord Nyb r Page
AT s
PROPERTY DESCRIPTION
District
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
iCounty Township - County Township
f hereby certify the above statements are true, correct and natu
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 112 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4) - —
-
-- •
-
(5)
Date Signed
�- 1 O p - 1
(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 112 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2.000
Valuation or $1,500
Valuation or $1,500
i
nature of Auditor
n)
Date Signed
�- 1 O p - 1
U