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Office of the Allen County Auditor Homestead Standard Deduction Audit Questionnaire Issued under the authority of Indiana Code 6-1.1-12-37 INSTRUCTIONS: Information requested relates to the property listed in Part 1. Return the completed form and necessary documentation to: Allen County Auditor’s Office, 1 E Main St, Ste 102, Fort Wayne, IN 46802 Phone (260)449-7241 PART 1: PROPERTY INFORMATION Street Address: City, State, ZIP Code: County: ALLEN Parcel ID: PART 2: OWNERSHIP TYPE: Note below the type of ownership for the property designated in Part 1 above. Choose those that apply below (individual, company, trust and/or other) INDIVIDUAL If there are additional owners of this property, please provide requested information on page two of this form. Owner First Name Owner Last Name Last 5 digits of Social Security Number Telephone Number Last 5 digits of Driver’s License Number Driver’s License Issuing State Do you currently live at the property listed in Part 1? If no, provide current address. Have you ever lived at the property listed in Part 1? Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Yes No Yes No Do you own other property in Indiana or another state that currently receives a principal residence deduction? If yes, provide the address of the property receiving a principal residence deduction. Spouse’s Full Name (first and last) Date owner purchased the property listed in Part 1 (mm/dd/yy). Yes No 2nd Owner Name (first and last) Relationship to above owner Last 5 digits of Social Security Number Telephone Number Last 5 digits of Driver’s License Number Driver’s License Issuing State Do you currently live at the property listed in Part 1? If no, provide current address. Have you ever lived at the property listed in Part 1? Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Yes No Yes No Do you own other property in Indiana or another state that currently receives a principal residence deduction? If yes, provide the address of the property receiving a principal residence deduction. Spouse’s Full Name (first and last) Date owner purchased the property listed in Part 1 (mm/dd/yy). Yes No COMPANY Company’s Legal Name Date Purchased By Company (mm/dd/yy) TRUST** Name of Trust or Life Estate Date Transferred Into Trust (mm/dd/yy) **Each grantor (creator) of a trust must complete the Individual section. If the grantor(s) of the trust is deceased, the trustee or all of the beneficiaries must complete Individual section and provide a copy of the grantor’s death certificate. Indicate by each name whether he/she is a grantor or beneficiary. Other Explain (example - land contract holder, life lease, renter, non-owner occupant). If you do not own but are residing in the property, please complete the occupant section on the reverse side of this document. If you no longer own this property, provide the following information and complete Part 2 above and Part 3 below: Name of Purchaser Telephone Number (if known) Date of Sale (mm/dd/yy) Sale Price PART 3: ALTERNATIVE USE OF THE PROPERTY Indicate the portion of the property rented or used for business purposes. Is the property located next to (contiguous or adjacent) the owner’s principal residence? If the property is next to (contiguous or adjacent) the owner’s principal residence, is the property vacant (no structures)? Rental Business Yes No Yes No For contiguous or adjacent properties with structures, describe the type of structures(s) garage, shed, cabin, house, mobile home) and the use of the property. Are you currently residing in a nursing facility? Yes No Are you a member of the armed forces away from your residence as a result of military service? If so, please provide a copy of your military orders. Is yes, provide the dates you have not occupied your home. From: To: Yes No ---PAGE BREAK--- Additional Owners – Complete this section for any additional owners. If additional space is required, please use the additional information space below or attach an additional sheet. Additional Owner First Name Additional Owner Last Name Driver’s License No. & Issuing State Telephone Number Do you currently live at the property listed in Part 1? If no, provide current address. Have you ever lived at the property listed in Part 1? Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Yes No Yes No Do you own other property in Indiana or another state that currently receives a deduction? If yes, provide the address of the property receiving a deduction. Spouse’s Full Name (first and last) Date owner purchased the property listed in Part 1 (mm/dd/yy). Yes No Additional Owner First Name Additional Owner Last Name Driver’s License No. & Issuing State Telephone Number Do you currently live at the property listed in Part 1? If no, provide current address. Have you ever lived at the property listed in Part 1? Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Yes No Yes No Do you own other property in Indiana or another state that currently receives a deduction? If yes, provide the address of the property receiving a deduction. Spouse’s Full Name (first and last) Date owner purchased the property listed in Part 1 (mm/dd/yy). Yes No Occupant Information - Complete this section only if you are an occupant and not an owner. If additional space is required, please use the additional information space below or attach an additional sheet. Occupant First Name Occupant Last Name Driver’s License No. & Issuing State Telephone Number Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Spouse’s Full Name (first and last) Do you own property in Indiana or another state that currently receives a deduction? If yes, provide the address of the property receiving a deduction. Yes No 2nd Occupant First Name 2nd Occupant Last Name Driver’s License No. & Issuing State Telephone Number Provide dates you occupied the property listed in Part 1 (mm/dd/yy). From: To: Spouse’s Full Name (first and last) Do you own property in Indiana or another state that currently receives a deduction? If yes, provide the address of the property receiving a deduction?. Yes No Additional Information – Complete this section if you have additional supporting information to supply. Under penalties prescribed by law, signing this form is an affirmation that the information is accurate and true to the best of your knowledge. Signed: Date: