Homestead_Bradshaw (3)CLAIM FOR HOMESTEAD PROPERTY TAX \ FORM YEAR
CREDIT /STANDARD DEDUCTION Hc�o
State Form 5173 (R614-03) n
Prescribed by the Department of Local Government Finance Vp
INSTRUC77ONS: See raverse side for filing insi ucdons. 'F7 g -r r1 T"1,
I (We) �1 �QX,S�P�[.o�� I� certify that on the tsIudebl oL)vler E23E
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract �� 0 �o
r-I Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propert&his� a �regvUnn Ir1� nUraj7pq
CONTRACTIRECORDEDi$1'
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
�%- airxH1"Y� PROP, ERTY:DESCRIPTION?t4'=
County
Tomishtp
Taring district (city, town, township)
P I n bar
L de
S
Address (number and street, city, state, ZIP code) C.
Is the property in question:
JO VO
"TRUE TAX�„m++g
,VALUE�r..h,�ry
ASSESSEDVALUE
"AT'100 %.OF TTV��,
❑ Real property ❑ Mobile Homo ( /.G 6-1.1 -7)
If any potion of the residential sWCbrre or tie bind not exceeding one (1) acre that immed' tey suoounds that structure is used to produce income, describe the use and portion
of tthhee/pippperrty�uyWliz to produce income.
/en /d
/ W1 Cwt' 7/
act -,0 /, �- W- 020,30
surrounding residential improvements.
ffPROP,ERTY;OWNED BY CLAIMANT.IN :OTHER'000NTIES g ` ,...i? j
County
Toomship
County Township
hereby certify the above statements are true, correct and complete. -
5 atur imam
Address (number and street, city, state, ZIP code) C.
Signature of Auditor
in
.,.:�?''" "ASSESSOR USE-ONLY r" r +'
"s>�'rr� �.� -".N vK- ?b;;f>w -... _.=%.7; i`X
"TRUE TAX�„m++g
,VALUE�r..h,�ry
ASSESSEDVALUE
"AT'100 %.OF TTV��,
-> O ESTFIIDF.x-
VALUECis
NO ESIDENTIAL .a
� Msr�" .VALUE..3.'rr�'s�r
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
un ,y'
!Residential impro vements or Annualy
". i, r'?5.,�,�a�l
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true. correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
t�t�ac '""1'r`"`�'�"5�r-�r3 ` ��STANDARD :DEDUCTIONiALLOWANCE;t`�',"��' �r- � ^
..-o- ra.•�• �,.,.Fd�w_. e1T >_< .. _a''fi.,H`�:e�:'��is'�i�Y'_•. �.e�O. - e6�S��maeti�..e
® 20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535,000
$
Signature of Auditor
in
Date signed
I
SLATE FORM n'MIR'r>AM • MEASLIER FORM iS:A
APPROVED BYSTATE BOARD OF ACCOUNTS."%V PREa xibm BY TFIF DEPARTMEIT OF LOCAL GOVERNMENT F NAY\'rE F 41.1-L4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eter for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to provide additional identifying information necessary to allow counts government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address ,�A e j
Bradshaw, Melinda 5 o 5 /Lt. r A j ( J-1--
Bon 57
- D - (b01'. a-d�
Patoka IN 47666
91
Melinda Bradshaw
505 N Main St State Parcel Number Legal Description
PATOKA IN 47666
26-04-24-302-000.304-020 018-00304-00 COL DIV 35PT/36PT
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I • First Middle ` Last
/,
Ong Address(nummmb_er and street,city,state,and ZIP code) Sam property address
'
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/Stare ID Number (last 5 digits) Other(please specify in Part 4 below)
Starr
-- - PART 3:CERTIFICATION' - `—`--
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes an substantial financial penalties.
Owner 1 S. nature Datc
Spouse Signature Date Telephone
( )
PART 4: ADDITIONAL INFORMATION
•