Homestead_Koelling (2) ,P %TATE I 11R%I MW,IR./fwd TIT/ZULU PDLV-•}IA
VPROVED BY NI AIL BOARD Of MY RUTS.4r.• PREYAT01])nY WI DEPARTMENT Of LOCAL GOVELYSITM17 FNA\CE eo-1.1.r-41
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
r more beneficial.there is more incentive than eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1:44--2009 requires taxpayers who retch e the homestead standard deduction to verity that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings,'flay information will be kept confidential and can only Iv 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, Brenda Kay
5791 S 10001:
Oakland City IN 47660
8568
Brenda Kay Koelling
5791 S 1000 E State Parcel Number Legal Description
Oakland City IN 47660-8556
Itinllntlrilnttlr lllnttututttultlulinitinnl11u 11rt 26-20-1 00-000.420-001 �01-00420-00 PT NW 1139.596 AC
D-8
Spouse First Middle Last
BreAiaA KAN JCoeLL, N9
Mailing Address(Number and street,city,stale,and ZIP code) Same as properly addrea
5791 S ! too E. c-)AK t ANfri (-Ili 1 yJ -I 1G,6 0
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.
IP
FORM HC 10 1979 To Be Filed in Duplicate
Prescrideo By State Board of Tax Commissioners
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19 17 '7
SEE BACK FOR FILING INSTRUCTIONS 001-00 4Z -Z'9 -00
(We) 04 c*� arc ct e. 7i�c
arch, 19_7 1 I, ( ) occupied as our principal place of residence
which a Homestead Property Tax Credit is hereby being claimed:
J
certify that on the 1st day of
following described real property for
I. (We) downed �%�.ad-������J -QGQ• /o�0-DO�
❑ are buying under contract
❑ have a beneficial interest in the taxpayer �t
Property Description in County Township
Taxing District (city; TewR, Township): Q�t -�n+ -L
Parcel Number or legal description shown on tax statement:
1pf. /11/4,c/ -y // -.g -9 • 15-9
If buying on contract: Owners name Dee 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
hereby certify the above statement is true, correct and complete.
® . . A - -
-Signature
Address
Cdy. State and Zip Code
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.
- FOR ASSESSOR'S USE ONLY -
Land not exceerlitatel
1
one)�acre ; meditil y
surrounding
resi ntia
imprgemeEss [ 67
Other Land
Total Land
JUN 19 1919
Residential
Improvements
Dwelling
4./, 2�,
Garage
AUDITOR Total
Other Improvements
Tot I Improvements - Line (6) plus (7) equals (8)
I aby certify the above is true. correct. and complete.
Assessor
True Cash
Value
(1)
(2)
(3) -5,0 0
(4)
(5)
(6)
(7)_3_7_4_D_
MMisl
- ACTION BY AUDITOR -
Assessed
Valuation
/7-0
Homestead
Valuation
-o9
Date
Approved: /( a- 1(�1� Date: / 197