Forms Management - SBS Portals

FORM
HC10

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

Reviewed

CERTIFICATION STATEMENT

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):

Own. Am (are) buying under recorded contract. Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust. Am (are) the shareholder, partner, or member of the entity that owns the property.

Note: Please provide two identification numbers for each person

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

Contract Recorded

Recorders office where contract is recorded

Record number

Page

PROPERTY DESCRIPTION

County

Township (optional)

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

Parcel number (optional)

Legal description (optional)

Property Location Address

Is the property in question:

Real property Annually assessed mobile home (IC 6-1.1-7)

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.

PROPERTY OWNED ELSEWHERE BY CLAIMANT

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

Claimant Details

Address of Claimant

Is claimant vacating a homestead?

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

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

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

Signature of claimant

Click here to sign