Year

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

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)

Driver’s Licence/Identification/Other number of Claimant (last 5 digits)

Issuing
State

Name of Claimant’s Spouse (legal name)

Phone

Email

Social Security Number of Claimant’s spouse (last 5 digits)

Driver’s Licence/Identification/Other number of Claimant’s spouse (last 5 digits)

Issuing
State

If Buying on Contract, Fee simple Owner’s Name

Recorders office where contract is recorded

Record number

Page

County

Township

Taxing district (city, town, township)

Parcel number

Legal description

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

Is claimant vacating a homestead?

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

 

Signature of claimant

Click here to sign

Address of contact (number and street, city, state, and ZIP code)

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

ASSESSOR USE ONLY

ASSESSED VALUE

HOMESTEAD VALUE

NON-RESIDENTIAL VALUE

Land not exceeding one (1) acre immediately
surrounding residential improvements

AV1

HV1

NR1

Other land

 

AV2

HV2

NR2

Total land (line 1 plus line 2)

 

AV3

HV3

NR3

Residential improvements or Annually Assessed Mobile / Manufactured Home - Dwelling

AV4

HV4

NR4

Residential improvements or Annually Assessed Mobile / Manufactured Home - Garage

AV5

HV5

NR5

Other improvements

 

AV6

HV6

NR6

Total improvements (line 4 through line 6)

 

AV7

HV7

NR7

Total value (line 3 plus line 7)

 

AV8

HV8

NR8

I hereby certify the above is true, correct, and complete.

Signature of Assessor

Click here to sign

Date signed (mm-dd-yyyy)

Verifying action - Signature of Auditor

Click here to sign

Date signed (mm-dd-yyyy)

20 ______ pay 20 ______ Lesser of 60% of the assessed value of the homestead or $45,000

 

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.

$

Signature of Auditor

Click here to sign

Date signed (mm-dd-yyyy)

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