Homestead_Davis (10)CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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CREDIT /STANDARD DEDUCTION HcTO
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
I (We) _ certify that on the 1 st day of March , 19 CtL
I (We) occupied as our principal place of residence the foil wing described real property for which a Homestead
Property Tax Credit is hereby claimed: rL,T /I (We) owned ❑ Are buying under contract
❑Have 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
PROPERTY DESCRIPTION
u i Tow Taxing Dist ri t ity, t n, township)
Parcel Number Legal D scripti
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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
County Township County Township
I hereby certify the above statements are true. correct andgn
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
Otherland
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 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
-
nature of Auditor
(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 112 Homestead
Lesser of 1/2 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
nature of Auditor
Date Signed