HomeMy WebLinkAboutHomestead_Hornby (4);n
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Slate Fonn 5473 (11211 -90)
INSTRUCTIONS: See reverse side for filing instructions.
_CERTIFICATION STATEMENT
FORM
HC 10
YMEAR
_I d
I (We) s ilify that on the 1st da q! tYl�rc�jo1 9
I (We) occupied as our principal place of residence the lot od real propertyY�oriwhich a Homestead
Oroperly Tax Credit is hereby claimed: (We) owned ❑ /�,er ,J�,yJcru�iSl conlracl
SI-lave a beneficial interest in the entity Ilia[ is liable for the properly 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
County Townshi Taxing District (City, town, township)
r I y r-_ Legal Descriplion O�O ^ el (o �O
II 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 [lie property utilized to produce income.
orb
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
Counly
Township
I hereby certify the above statements are true, correct and Sign re
rplele. /�(
VWJiess (Street, number, city, state and ZIP code)
ASSESSOR USE ONLY TnUE TAX VALUE ASSESSED VALUE IIOMESTEAD VALUE NON- RESIDENTIAL
VALUE
Land not exceeding I (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)
(I)
1991 Pay 1992
19— Pay 19 -
sser of 1/2 1lomeslead
(2)
Lesser of 1/2 1lonrestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(A)
Signature of Auditor
(5)
(6)
(7)
(8)
I hereby certify the above is true,
correct, and complete
Signature of Assesor
Dale Signed
Verifying Action - Sgnature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19— Pay 19 -
sser of 1/2 1lomeslead
Lesser of 112 1lomeslead
Lesser of 1/2 1lonrestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
Signature of Auditor
Uale Signe