Year

INSTRUCTIONS: Click here for filing instructions.
NOTE: Telephone, Social Security, drivers license, state identification and federal identification numbers are confidential under IC 6-1.1-12-37.

Special Instructions

I (We) First Name

Last Name

certify that I (we) occupied as my (our) principal place of residence or am (are) buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed,

Date of Signature (mm-dd-yyyy)

I (We):

Name of Claimant (Legal Name)

Phone

Email

Social Security Number of Claimant (last 5 digits)

Drivers License number of Claimant (last 5 digits)

Issuing
State

Other US issued ID number of Claimant (last 5 digits)

Type of ID

Name of Claimants Spouse (legal name)

Phone

Email

Social Security Number of Claimants spouse (last 5 digits)

Drivers License number of Claimant Spouse (last 5 digits)

Issuing
State

Other US issued ID number of Claimant Spouse (last 5 digits)

Type of ID

If Buying on Contract, Fee simple Owners Name

Recorders office where contract is recorded

Record number

Page

County

Township (optional)

Taxing district (city, town, township) (optional)

Parcel number (optional)

Legal description (optional)

Property Location Address

Is the property in question:

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.

State, County, and Township (enter N/A if not applicable)

Is claimant vacating a homestead?

Address of Claimant

Address of vacated homestead, if any (number and street, city, state, and ZIP code)

I hereby certify the above statements are true, correct, and complete.

Signature of claimant

Click here to sign

If address of Claimant is different than Property Location Address, please explain.

20 ______ pay 20 ______ Lesser of 60% of the assessed value of the homestead or $48,000

Notwithstanding any other provision, the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half (1/2) of the assessed value of the mobile home or manufactured home.

Attach documents if requested by Auditor

DISTRIBUTION: Original - County Auditor, File-Stamped Copy - Taxpayer