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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION

State Form 5473 (R15 / 5-14)
Prescribed by the Department of Local Government Finance

FORM
HC10
 
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.
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):
          
CLAIMANT’S INFORMATION
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
CONTRACT RECORDED
If Buying on Contract, Fee simple Owner’s Name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
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.

PROPERTY OWNED ELSEWHERE BY CLAIMANT
State, County, and Township
Is claimant vacating a homestead?
    
I hereby certify the above statements are true, correct, and complete.

 

Signature of claimant
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
Date signed (mm-dd-yyyy)
Verifying action - Signature of Auditor
Date signed (mm-dd-yyyy)
STANDARD DEDUCTION ALLOWANCE
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
Date signed (mm-dd-yyyy)
DISTRIBUTION: Original - County Auditor, File-Stamped Copy - Taxpayer


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