Homestead_Koelling r' cl tE Font!3S ,0./,wt TRTATntrR FORM fl-tA
rGibson County Auditor
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EIMPORTANT NOTICETO HOMESTEAD FPROPERTY OWNERS II AI:tot PISSOULID BY no
101 N Main
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for homestead fond.Homestead fraud causes higher tax bills for all:therefore.
�\ HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reeene the
benefit and to provide additional identifying information nem>,ry to allow county government to better monitor homestead
filing:,This infmnutinn will he kept confidential and can only he 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
Koelling, Carl Delbert/Patty L
4.1Z;161r
Oakland City_1X47660
8567
Cad Delbert/Patty L Koelling
5577 S 1000E State Parcel Number Legal Description
Oakland City IN 47660-8558
I I I I III I I I I I I I I III I I I I I I I I 26-20-11-100-000.419-001 001-00419-00 PT NW 11-3-9 1.009 AC
t o tit t tit n tit n n r n r t u t tit tat tit / D-8
PART 2:TAXPAYER INFORMATION
Owner I First Middle - Last
r - - 1c e'rfi
Ig Address(number and s'• E city,stat ,and ZIP code) - - - _r - -_ — - U Same-as-Property id. -. --
Spouse Fi Middle Last
&a Ly eoeitl' 41
Mailing Address umber and street.city.state,and ZIP cock) ❑ Same as property address
So V» P
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 Signature �, Date
•
FORM HC 10 1919
Nesttibed By Slate Board of Tax Commissioners
To Be Filed in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 Z2
SEE BACK FOR FILING INSTRUCTIONS
®(We)� y 9�lTa w /7 ^eer y certify that on the 1st day of
larch, 19 I, (W occupied as our principal place residence the f6dowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned �(O o)O �� ��� OQO . �7 —G��
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in — County A Township
Taxing District (Gitq- Tome, Township): ���
Parcel Number or legal description shown on tax statement:
pt.'s/uTy //-3-91 /.om9
If buying on contract: Owners name ltee simple owner)
Contract recorded in Recorders Office - Record
If any portion of 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: County Township
I hereby certify the above statement is true, correct and complete.
®_ /'6 X-b�
('Sig�ature Street Address
' y. State and Zip Cdde
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or
has a beneficial interest in the taxpayer.
ASSESSOR'S USE ONLY -
LFOR
t�
E D
True Cash Assessed Homestead
ids+
Value Valuation Valuation
Land not exceeding 1 (one) acre immediately
surrounding resideq.t l Ltnpr?C��Inenis
1 "P"
Other Land
Total Land ti
Residential ro rents AUDITOR Dwelling
Garage
Total
Other Improvements
Tn+ l ,Improvements - Line (6) plus (7) equals (8)
Loby4ertify the above is true. correct. and complete.
Signature
(t) �'oo
(2) / o
(3)
(4)
(5)
(6) 22 / 9 5 0
(7) 3 7 0
(8) ? .7 3 a 0
- ACTION BY AUDITOR_:
i 249
Approved: j4 L�p A Date: ,� l 9