Form 104-C - Consolidated Return Business Tangible Personal Property (2008) Page 2

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Name of County

Summary of Assessed Values for all Locations in This County

(attach additional sheets, if necessary)

Additional sheets attached

LOCATION

DBA NAME & ADDRESS

DLGF TAXING

TOWNSHIP

VALUES

DEDUCTIONS

NUMBER

(number and street, city, state, and ZIP code)

DISTRICT NO.

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

TTV before

PPID

deductions

PENALTIES FOR FAILURE TO FILE COMPLETE RETURN FORMS

Failure to file a return on or before the due date, as required by law, will result in the imposition of a twenty-five dollar ($25.00) penalty. In addition, if a

return is not filed within thirty (30) days after such return is due, a penalty equal to twenty percent (20%) of the taxes finally determined to be due with

respect to the property which should have been reported will be imposed. A personal property return is not due until the expiration of any extension period

granted by the township assessor under IC 6-1.1-3-7(b).

If the total assessed value that a person reports on a personal property return is less than the total assessed value that the person is required by law to

report and if the amount of the undervaluation exceeds five percent (5%) of the value that should have been reported on the return, then the county auditor

shall add a penalty of twenty percent (20%) of the additional taxes finally determined to be due as a result of the undervaluation.

In completing a personal property return for a year, a taxpayer must make a complete disclosure of all information relating to the value, nature or location

of personal property owned, held, possessed or controlled on the assessment date [IC 6-1.1-3-9(a)], and information relating to improvements made since

the preceding assessment date to real property owned, held, possessed or occupied [IC 6-1.1-5-13]. This information would include, but not be limited

to, completion of the heading and related information, answers to all questions and entries on all of the appropriate lines on the face of the return. If such

information is not provided, the taxpayer will be contacted and directed to provide that information. In addition, a penalty of twenty-five dollars ($25.00)

may be imposed. [IC 6-1.1-37-7(d)]

The above penalties are due on the property tax installment next due for the return whether or not an appeal is filed with the Indiana Tax Court with respect

to the tax due on that installment. [IC 6-1.1-37-7(f)]

SIGNATURE AND VERIFICATION

Under penalties of perjury, I hereby certify that this return (including accompanying schedules and statements), to the best of my knowledge and belief,

is true, correct and complete; reports all tangible personal property subject to taxation, owned, held, possessed or controlled by the named taxpayer in

the stated township or taxing district on the assessment date of this return, as required by law; and is prepared in accordance with IC 6-1.1 et seq., as

amended, and regulations promulgated with respect thereto.

Signature of authorized person

Printed name of authorized person

Date (month, day, year)

Title

Telephone number

Signature of person preparing return based on all information of

T elephone number

which he has any knowledge

(

)

(