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              NOTICE OF CHANGE OF USE OF PROPERTY                                                                                                         FORM HC10/CU
              RECEIVING THE HOMESTEAD STANDARD DEDUCTION                                                                                                  ASSESSMENT DATE
              State Form 54890 (R / 1-16)
              Prescribed by the Department of Local Government Finance                                                                                    January __, 20 ___

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 (legal name)                                                                                                                         Telephone number
                                                                                                                                                          (               )
Social Security number of taxpayer (last five digits)        Driver’s license / Identification / Other number of claimant (last five digits)          Issuing State
                                                             (Applicable only if applicant does not have a Social Security number.)

Name of taxpayer’s spouse (legal name)                                                                                                                Telephone number
                                                                                                                                                          (               )
Social Security number of taxpayer’s spouse (last five digits) Driver’s license / Identification / Other number of taxpayer’s spouse (last five digits)  Issuing State
                                                             (Applicable only if applicant’s spouse does not have a Social Security number.)

                                                                       CONTRACT RECORDED
If buying on contract, Fee Simple owner’s name

Recorder’s 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:
                                                                                                       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             Printed name of taxpayer or authorized representative                         Date signed (month, day, year)

DISTRIBUTION:  Filed Stamped Copy - Taxpayer; Original - County Auditor