Certification Of Eligibility For Personal Property Exemption Form

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CERTIFICATION OF ELIGIBILITY FOR PERSONAL PROPERTY EXEMPTION
PURSUANT TO IC 6-1.1-3-7.2
Beginning in 2016, IC 6-1.1-3-7.2 provides an automatic exemption for a taxpayer’s business personal property in a county if the
acquisition cost of that taxpayer’s total business personal property in the county is less than $20,000 for the assessment date.
For purposes of this exemption, “acquisition cost” means the cost of the business personal property:
(1)
acquired in an arms-length transaction from an entity that is not an affiliate of the taxpayer, if the personal
property has been previously used in Indiana before being placed in service in the county; or
(2)
acquired in any manner, if the personal property has never been previously used in Indiana before being placed
in service in the county. IC 6-1.1-3-7.2(c)(3).
A taxpayer that is eligible for the exemption is not required to file a personal property return for the taxpayer’s business personal
property in the county for that assessment date. However, the taxpayer must, before May 15 of the calendar year in which the
assessment date occurs, file
annually
with the county assessor a
notarized certification
signed under penalties for perjury stating
that the taxpayer’s business personal property in the county is exempt from taxation for that assessment date.
A taxpayer believing he qualifies for this exemption is encouraged to review IC 6-1.1-3-7.2 in consultation with his legal counsel
and/or financial advisor before signing this certification. Only one annual certification is required for each county where the taxpayer
is eligible.
If a person fails to timely file the annual certification, the county auditor must impose a penalty of $25 that must
be paid by the person with the next property tax installment that is
collected.
PLEASE NOTE: A taxpayer who owns, holds, possesses or controls leased or rented personal property may, as deemed necessary
by the county assessor, need to file Form 103-O or 103-N, as applicable, to verify that he is the appropriate taxpayer to claim this
exemption.
TAXPAYER INFORMATION (TO BE COMPLETED BY TAXPAYER).
Full name of taxpayer:_______________________________________________________________________________________
Doing business as (DBA):____________________________________________________________________________________
EIN: _____________________________________________________________________________________________________
Mailing address of taxpayer (number and street, city, state, ZIP code):_________________________________________________
Phone number of taxpayer:_________________________ E-mail address: ____________________________________________
Check this box if taxpayer is a public utility subject to IC 6-1.1-8: □ If checked, indicate if taxpayer would ordinarily file 1.□ Form 103
with the county or 2.□ UD-32 or UD-45 with the Department of Local Government Finance, respectively. If box 2 is checked,
taxpayer should file a copy of this certification with the county assessor and the DLGF.
TAXING DISTRICT NUMBER(S): _____________________________________________________________________________
PARCEL or PROPERTY ID NUMBER(S) (if known by taxpayer):____________________________________________________
PROPERTY ADDRESS(ES) WHERE ASSETS ARE LOCATED: _____________________________________________________
ESTIMATED TOTAL ACQUISITION COST OF TAXPAYER’S PERSONAL PROPERTY IN THIS COUNTY: __________________
(ATTACH ADDITIONAL PAGES AS NEEDED.)
CERTIFICATION STATEMENT
I, _____________________________________________, under penalties of perjury, certify that the business personal property
owned by _____________________________________________ (insert name of taxpayer), acquired and placed in service in
____________________ County, Indiana, is exempt from taxation for the January 1, 20__ assessment date pursuant to IC 6-1.1-3-
7.2.
Signature of the authorized person:_____________________________________________ Date (month, day, year):____________
Subscribed and sworn to before me this _______ day of __________________, 20_____.
__________________________________________________
Notary Public
My commission expires: ______________________________
__________________________________________________
(Name of Notary Public)
Resident of _____________________ County
PREPARER INFORMATION (TO BE COMPLETED BY PREPARER)
Full name of person signing certification statement above: __________________________________________________________
Relationship of person signing certification statement to taxpayer (e.g., “self,” “agent,” “attorney”) (attach Power of Attorney, if
applicable): ____________________________________
Mailing address of person signing certification statement, if different from address above (number and street, city, state, and ZIP
code):____________________________________________________________________________________________________
Phone number of person signing certification statement, if different from phone number above: _____________________________
THIS SECTION RESERVED FOR ANY ADDITIONAL INFORMATION THE COUNTY ASSESSOR MAY NEED.

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