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NOTICE OF CHANGE OF USE OF PROPERTY
FORM HC10/CU
RECEIVING THE HOMESTEAD STANDARD DEDUCTION
ASSESSMENT DATE
(mm-dd-yyyy)
State Form 54890 (R / 1-16)
Prescribed by the Department of Local Government Finance
Special Instructions
Reviewed
INSTRUCTIONS:
1. Please type or print.
2. This form must be filed with the County Auditor within sixty (60) days after the date that the property no longer qualifies for the Homestead Standard Deduction. IC 6-1.1-12-37(f)
3. A change in use of or title to a property may disqualify it for a homestead deduction or require the deduction to be re-filed.
NOTICE: An individual who fails to file this form in a timely manner is liable for any additional taxes that would have been due on the property plus a civil penalty of 10% of the additional taxes due. IC 6-1.1-12-37(f)
TAXPAYER INFORMATION
Name of taxpayer (Last, First)
Telephone number
Email
Social Security number of taxpayer (last five digits)
Drivers license / Identification / Other number of claimant (last five digits)
Issuing State
Marital Status
Married
Not Married
Name of taxpayers spouse (legal name)
Telephone number
Social Security number of taxpayers spouse (last five digits)
Drivers license / Identification / Other number of taxpayers spouse (last five digits)
Issuing State
CONTRACT DETAILS
Contract Recorded
No
Yes
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page number
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
Legal description
Is the property in question:
Real property
Annually assessed mobile home (IC 6-1.1-7)
Address (number and street, city, state, and ZIP code)
Portion of property no longer eligible:
All
Part
Description of the change in use or the reason that the property no longer qualifies for the deduction.
CERTIFICATION STATEMENT
I hereby certify that the information contained in this notice is true, correct, and complete.
Signature of taxpayer or authorized representative
Click here to sign
Printed name of taxpayer or authorized representative
Date signed
(mm-dd-yyyy)
DISTRIBUTION:
Filed Stamped Copy - Taxpayer; Original - County Auditor
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