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d�'�� CLAIM FOR FIOMESTEAD PROPERTY TAX : �,� � nn
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,�' �� CREDIT/STANDARD DEDUCTION f c�o -� �
�� ,� Slale Form 5473 (R2/1-9U)
b" ` INSTRUCTIONS: See reverse side for lrling inslructions. MAY 6 1992
CERTIPICATIOtJ STATEMENT ,�{�lyr,�,� ,�}". s
I(We) Q�D� �. � certify thal on the tst day ot March , 19 �
I(We) occupied as our principal pl e of residence Ihe followiny described real property for vahich a I-lomestead
Tax Credit is hereby claimed: �e) owned ❑ �re buying under contract
� liave a benelicial interesl in Uie entity Ihal is liable Ior the property (axes on Ihe properly and Ilial owns Ihe
properly or is buying it under a conlracl.
CONTRACT RECORDED
II buying on contracl, Fee Simple Owner's Name
Recoider's ollice where conlracl is recorded fiecord Number Paye
PROPERTY DESCRIPTION
(Cily, lown, lownship)
Parce Nu er Legal Uescriptiii v
�S -o`��og .�- �w 3�-a - i � �. 9 ��
If any porlion of Ihe residenlial slrucWre or Ihe land nol exceeding one (1) acre Ihal immediately surrounds Ihal slruc-
tuie is used to produce income desciibe Ihe use and poriion ol lhe pwperly utilized to pwduce income.
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PROPERTY OWtJED BY CLAIMANT IN OTHER COUNTIES
ASSESSOR USE ONLY TfiUE TA% VALUE ASSESSED VALUE tIOMESTEAO VAIUE NON-RESIDENTIAL
VALUE
Land nol exceeding 1(one) acre immedialely
surwunding residenlial improvemenis ( � )
Olherland (2)
Tolal land - line (1) plus line (2) (3)
fiesidenlial improvemenis Dwelling (4)
Garage (5)
Olher improvemenls (6)
Tolal improvements • line (4) Ihrough line (6) (7)
Tolal value - line (3) plus line (7) (8)
I hereby ceility ihe above is true, Signalure ol Assesor Date Siyned
correcl, and complele
Veiilying ction - Signalure ol Auditor Uate Signed
1989 Pay 1990
Lesser of t/2 liomestead
Valualion or $2,500
Signalure of Audilor
STANOARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser ol V2 I bmeslead
Valualion or $2,000
�
1991 Pay 1992 19—Pay 19—
Lesser ol 1l2 Horneslead Lesser ol 1/2 Flomeslead
Valuation or $1,500 Valuatio�i or $1,500
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