Homestead_KuehlingFORM HC 10 19i9
Prescribed By 9ate Baare of iaz Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19� l_
SEE BACK FOR FILWG INSTRUCTIONS
� (We) �1111.�_rt�.l Q . �� MP 11 P��n�-�Lx �-'-`
March, 19�4 , I, (We) occu i as our n i al lace of residen
which a Hom stead Property Tax Credit is hereby being claimed:
I, (We) owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Tazi�g!Di_strict�{Ciry!JTown, Township):
Parcel Number
f��; 0 3 1 ��`'�
�� T" r (fee sfmo�e owner)
If-bdytag° on contracf-:Owners name
IiS1J�iQf'1 �
To Be Filed in Duplicate
certify that on the 1st day of
following described real property for
o �(� -a!� s3 0 �
Township
or legal description shown on tax statement:
�t-t,���a a1�-1�4 R �-ld a�c..
Contract recorded in Recorders Office - Record
If any portion ot the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�he by certify the above statement is true, correct and complete.
(/��� �������
Suee� Aaaress
County Township
u�y. atate ano [iv �e
' Individual either owns or is buying under a contract that provides he is to pay ihe property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total Land
Residential Improvements
Dwelling
Garage
Total
Other Improvements
T Improvements - Line (6) plus (7) equals (8)
I ���reby ceriify the above is true. correct. and complete.
Signamre ol Assessor
Approved
True Cash
Value
(1)
(2)
(3)
(4)
(5)
(6)
p)
(8)
- ACTION BY AUDITOR -
Assessed
Valuation
oare
Homestead
Valuation
`- 3--�
Date: �
�
• ��
Gibson County Auditor
101 N Main
PRINCETON IN 47670
3375
Freddie Ray / Pansy L Kuehling
1527 Outer Lake RD
PrincetonlN 47670
SIUEfORNAM�ICI)+nl
i
i lAE [IIAIAfU0.V 31�
hWiviJual. anJ �mrriN couple.: arc limimd m nre home9ead �andaN Aeduninn. A> Ne receip� 01 thi: deductan beconm
mare beneficial, there i. morr inceneire clun ecer (or honxsteazl fnuJ. Ilon�tt:rJ frawl cau.ses higher tu t�ills fur aIC therefore.
HEA IiJi-?IX19 requires uxp+cers who rttrirc ihe hanesicaJ sundaN Jntuaion w verily tlui �hey am elieiWe w rcc.i.r the
benefi� anl io p�m�id< aJJitioml identitrinc infumurun rieasa�n� io allw' cwnn� eo.'emment ro betrc� mmfror homes:eaJ
tilin�.'Ihix inlormaiion wiil M Aryw contidr.ntial and nn nnly h• ures�eJ M1r awhnrizni cnnmy oRci�ali The Ikpannmm ol
Lural Govemment Finanee ��ill u.e this intormation to areute twls Ihat will h:lp avunrv u(ficials dimieinie hum<stcad kauJ.
�� �� �
Taxnacer Name Prnnert� Address
Kuehling, Pansy �
�
� IS?7 OuterlakeRD
I'rincclon 1��47670
�
�ner I First
/ ;liii' S}� /�.e d c.�iv�
� Address (numbQ and ittcct, ciN, statc, nnd ZIP code)
� t� G! / /�/!I / P.L L.�/I Y � /� J .4 �Y — / .f • �
Kial Securil}' Number (last i dieiLS) Drivds License/Stam ID Nmnber (Is.l 5
���
Addrtss (Number and Slreei, cil}', 51a1e, nnd ZII' calr)
�
Stturiq� I�umber (last 5 digi�) � Drivcrs Limnsc/5�a[c ID Nmnbcr (Itit 5
State Parcel NumAer
26-12-09-103-001.153-027
�
Leeal Descrirition
OOG0115100 PT W I�JW 9 2 10 2 AC
C-1
%�u e,�i G��y
Sarue ns propem udd�ess� �
� san,e u p�openy marev
hlow)
176 �
i
I
;
I
idersitmed certifies, under penalty of perjury, that the above and furegoing in(ortnstion is we and co�rect and that he or she is eligible to
the homeslead standard deduclion on this property. Each undzrsicned al;o understands lhat, by claiminc additional home>tead deductions
illy, he or she may be liable for back taxes and substantial financial penalties. � ��
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