Homestead_Bradshaw SLATE FORM n)'MIR_I Nen TALAnitnl FORM 75-1A
AITREIVED BY MATE bIARDOF'AIY[R.TS.}m PRrAIUBm BY TIE DEPARnSBNr(firs'.LLrovrLYMrA'I FINANCE tcwl.l-u'I.I
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
risk more beneficial,there is more incentive than ever for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receive the
benefit anti to provide additional identifying infomvtuon necessan'to allow Mounts'government to better monitor homestead
filings.This information will he kept tonildential and son only be accessed by authorized county officials.The IkpannTalt of
Local Government Finance will toe this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Bradshaw, Jerry Ross Jr/Lisa M
202 S Fastview
Fort Branch IN 47648
7784
Jerry Ross/Lisa M Bradshaw Jr Jr.
202 S Eastview State Parcel Number Legal Description
Fort Branch IN 47648-1403
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
�g Address(number and street.city.state, d ZIP code) - - - - - - - NKamc as property address
an - - -'
20.. 5, E;7--17 -1', w s7= F-/e 111,111e4 -rte q)e `t
Spouse First Middle' Last
/14 ER4dsti Ivo
Mailing Address(Number and street,city,stale,and ZIP code) i 'Same as propeny address
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 and substantial financial penalties.
Owner I Si nature Date Telephone
2-10 (f/? ) 7x-3-3�s7
S Si rare Date Telephone
/71 / /O (l2) 7.5 1
PART 4:ADDITIONAL INFORMATION
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92) '
INSTRUCTIONS: See reverse side /or /iling inshuctions.
FORM
HC10
YEAR
- � TIPICATION STATE ENT
I(VJe) - certify t at on ihe lst day of March, 19_
I(4Ve cu d as o p cip place of residence the tollowing escribed real property tor which a Homestead Pro 7 rt is e j� �Ja mi ed:
r t
I(We) owned Are buying under contract ���
❑ Have a beneficial interest in ihe entity that is liable for the property taxes on the property and that owns the property or is buying under a contraci.
JUN
� CONTRACT RECORDED
It buying on comrect, Fee Simple ownets name (��
: -��-�--�-�
Pecorders oRice where contrad is recoNed � rU'nuin6'e'rt r n � t �. Page
PROPERTY DESCRIP N
Counry Township Taain rict ( N, t tm shrP)
� I ump¢r O �� ,\ Legal descnption
LJ U
If any portion of the resi0ential structure or the land rwi exceetling one (1) acre that immediatey surtounds ihat struc[ure is usetl m produce income, describe the use and portion of
ihe pmperry ulilizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Couny , Township I
Signa ure of claimant
ereby ceRify the above statements are true, correct and complete.
M.
Address (number and streef. dry, sfate, ZIP codeJ
F . (, ,v. (,
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1(oneJ acre immediately �� �
surtounding residential improvemenis.
ONer land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4) �
Residential improvements _
Garage (5)
Olher improvements (6)
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
1 hereby certify the above is �rue, Correc[, and Signature of Assesor Date signed
complete.
Veritying action - Signamre ot Auditor Date signetl
�� STANDARD DEDUCT70N ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or ,000
Signature o� Audilor Date�ignetl� C j� Q Q
a ; i