Homestead_Elpers (2) •lAlE FORM')YIK'I%1 1 TRFAWRRrOR431A
ArrKtwtD BY CrtUE WARD OF MYt1le.7A.20 N YtI R1MD BY nn DEPARTHENTOr LOCAL IXTtP.YMrta FD&SCEW 4-1.1"4.1
I' 0 County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
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 din eser 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 receise the
benefit and to provide additional identifying informaron necessary to allow county government to better monitor homestead
tilings.This information will he kepi conlidemial and can only be arce.sed by authnriied county officials.'the Depanment 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
_ Elpers, Jason B/Stacy Lynn
305\V Foster
Fort Branch IN 47648
6993
Jason B Elpers
305 W Foster State Parcel Number Leal Description
Fort Branch IN 47648-1533
Itlullu rlrllua1u11u 1nu11t ltlntllntll teen nett ltl toll 26-18-24-201-000.886-026 011-00886-00 LAGRANGE ENLG 215 PT
. PART 2:TAXPAYER INFORMATION
Owner I - First Middle Last
L\c� �� .. I. \ ass
g Address(number and stem city,state,and ZIP code) - - - - - 2 Sartre as pro ny address -' - - - -- -
Spouse ��,,11 First Middle Last
&QCt• I�UYlS� 1
Mailing Address(Numbe d street city'.state.and ZIP cote) `' Same as hroperty 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 1 Signe Date
II
`'��" CLAIM FOR HOMESTEAD PROPERTY TAX
`�� °:.
� ' CREDIT/STANDARD DEDUCTION
.
� 1' State Fortn 5473 (R2 / S92)
�i , __, .%' .
� INSTRUCTIONS: See �everse side /or filing instructions.
FORM YEAR
� H � j p ��; �
+:, ..i r A..–n,� ✓
' �\ V � �O�a
CERTiFICATION STATEMENT
I (We) ce • •`
i_'� - �c r^�t�e.... ����-. �—
I(We) occupied as our pr cipal place o esidence the following described real property for which a Homestead Proper�y�TarzLYedit is'hereb�cFaimed:
�(We) owned ❑ Are buying under contract
Have a beneficial interest in the eniiry that is liable for the property taxes on the property and that owns the property or is buying under a contraci.
CONTRACT RECORDED � �
If buying on contraa, Fee Simple owners name
Recordets otfice where contraci is recorded � - Record number � . Page
PROPERTY DESCRIPTION -
Counry Township Ta<ing distric ciry, town, townshipJ
Parcel number Leqal tlescnption
� �� W
If any portion of the residential s[ructure or Ne land rroi exceeding one (1) acre that immetliatey surtountls thai structure is used ro produce income, tlescribe the use antl ponion of
ihe property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Tawnship Couniy Township
Si nature ol aimant
�ereby certify the above statements are We, correct and complete. c�
Adtlress (number and sf2et, ciry. state, Z/P code) n ' {�
0 S (u �- �.�t �i6 � O
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi ezceeding 7(one) acre immediatety (��
surtounding residential improvements.
Othertand (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6) .
Total improvements (line 4 through line 6) (7)
Tota1 value (line 3 plus line 7) (8)
i hereby ceRify lhe above is tNe, correct, and Signawre of Assesor Date signed
complete.
Veritying action - SgnaWre of Autliror Date signed
�S STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead g
Valuation or 52,000
Signature of Auditor � Date signed
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