FORM 130
PETITION TO THE PROPERTY TAX ASSESSMENT BOARD
FOR ASSESSOR'S USE ONLY
OF APPEALS FOR REVIEW OF ASSESSMENT
PETITION NUMBER
State Form 21513 (R5 / 11-01)
Prescribed by the Department of Local Government Finance
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Co.
Dist.
Yr.
Prop.
Sequence
Class
Check type of property under appeal: (check only one )
Real
Personal
Property Class
1. Agricultural
5. Residential
2. Mineral Rights
6. Mobile Homes
3. Industrial
7. Personal
4. Commercial
READ IMPORTANT FILING INFORMATION BEFORE COMPLETING THIS FORM
FILING INFORMATION
AN ORIGINAL AND ONE COPY OF THIS PETITION MUST BE FILED WITH THE COUNTY ASSESSOR
FILING DEADLINE: A petition for the current tax year must be filed with the County Assessor within 45 days after notice of change in assessment is given to
the taxpayer, or May 10 of that year, whichever is later. For real property, any petition filed after this deadline will result in the petition being reviewed for the
following assessment year, provided it is not a general reassessment year. (For example: a petition filed May 15, 2003, not based on notice of change in
assessment, would be considered a petition for tax year 2004). Ind. Code Sections 6-1.1-15-1 and -2.1.
MULTIPLE PARCELS OR TYPES OF PROPERTY: Petitioners wishing to appeal more than one parcel must file a separate petition form for each
parcel. Petitioners wishing to appeal both personal and real property assessments for the same parcel must complete a separate petition form for each type
of property. Please attach a list of related parcels currently under appeal.
GENERAL INSTRUCTIONS
1. Please print or type.
2. The petitioner must complete Section I, Section II, and Section III of this petition.
3. The petition must be signed by the petitioner or an authorized representative. A representative must attach a notarized power of attorney unless the
representative is a duly authorized employee or corporate officer of the taxpayer.
Yes
No
Is a power of attorney attached?
4. Certified Tax Representatives must attach a Tax Representative Disclosure Statement. 50 IAC 15-5-5.
5. Notify the County Assessor of any change in your mailing address or telephone number subsequent to the filing of this petition.
FAILURE TO FOLLOW INSTRUCTIONS: If a taxpayer does not comply with the instructions for completing this petition, the County Assessor will
notify the taxpayer of any defect in the completion of the form and will return the form to the taxpayer. The taxpayer will then have 30 days from the date
of notice of defect to correctly complete the form and resubmit it to the County Assessor. If the resubmitted form does not comply with the instructions
for completing the form, the County Property Tax Assessment Board of Appeals will deny the petition.
As a result of filing this petition, the assessment may increase, may decrease, or may remain the same.
SECTION I: PROPERTY AND PETITIONER INFORMATION
Is this property currently under appeal for another tax year?
Yes
No
If yes, indicate year(s) and type of appeal(s): _______________________________________________________________________________
Parcel or Key number (for real property)
County
Township
Address of property
City
ZIP Code
Legal description provided on Form 11 or Property Record Card (for real property) , or business name (for personal property) Assessment year under appeal
MARCH 1, ______________
Name of property owner
Area code and telephone number of property owner
Address of property owner
City
State
ZIP Code
Name of authorized representative (if different from taxpayer)
Area code and telephone number of authorized representative
Address of authorized representative
City
State
ZIP Code
Form 130, page 1