Fillable State Form 21521 - Notice Of Assessment/change printable pdf download

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NOTICE OF ASSESSMENT / CHANGE

ASSESSMENT DATE

(By An Assessing Official)

FORM 113 / PP

MARCH 1, 20______

State Form 21521 (R7 / 10-10)

Prescribed by the Department of Local Government Finance

Notice to the taxpayer of the Opportunity to Appeal (IC 6-1.1-15-1):

If a taxpayer does not agree with the action of the assessing official giving this notice, the County Property Tax Assessment Board of Appeals will review

that action if you file a notice in writing with the Township Assessor (if any) or the County Assessor within forty-five (45) days of the mailing of this notice.

This written notice should include the name of the taxpayer, the address of the property, the key number or the parcel number of the property, the address

of the taxpayer (if different from the property address), and the telephone number of the taxpayer. An appeal of this assessed value requires evidence

relevant to the value of the taxpayer’s property as of the assessment date.

Name of taxpayer

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

You are hereby notified that the undersigned assessing official has taken the action described below with regard to the following property:

LOCATION OF PROPERTY

County

Township

Taxing district

Address where property is located (number and street, city, and ZIP code)

DESCRIPTION OF PROPERTY

Farmer's Personal Property (Form 102 )

Business Personal Property (Form 103 )

Public Utility Company (Form 1) (deductions only)

ACTION

Assessed value before deductions has been changed from $ ________________________ to $ ________________________ .

Assessed value of a deduction was changed from $ ________________________ to $ ________________________ .

Failure to file required assessment return. Assessment has been estimated to be $ ___________________________________ .

Other (explain ) __________________________________________________________________________________________________________

__________________________________________________________________________________________________________

REASON(S) FOR ACTION

Failure to file required assessment return. You have the right to file an assessment return within 30 days of the first notice. (IC 6-1.1-3-15)

Mathematical error (describe below)

Omitted property (describe below)

Mandatory or allowable adjustment not properly computed or disallowed: (describe and state below)

Abnormal obsolescence adjustment disallowed [be sure to specify reason(s)]

Exemption disallowed (describe and give reasons):

In-whole

In-part

Industrial waste control equipment not certified by

Air pollution control equipment not qualified

Department of Environmental Management

Other __________________________________________________________________________________________________________________

Description or reasons (attach additional sheet if necessary)

Date of this notice (month, day, year)

Name (please print)

Telephone number

Title

Signature

(

)

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

State Form 21521 - Notice Of Assessment/change

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