State Form 11274 - Business Tangible Personal Property Return - 2016 Page 2

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SECTION V

FORM 103-SHORT FORM

SCHEDULE A

CONFIDENTIAL

See 50 IAC 4.2-4

JANUARY 1, 2017

COLUMN A

COLUMN B

LINE

YEAR OF ACQUISITION

DEPRECIABLE PERSONAL PROPERTY

TOTAL COST

T .T .V.%

TRUE TAX VALUE

1-2-16 To 1-1-17

3-2-15 To 1-1-16

3-2-14 To 3-1-15

3-2-13 To 3-1-14

3-2-12 To 3-1-13

3-2-11 To 3-1-12

3-2-10 To 3-1-11

3-2-09 To 3-1-10

3-2-08 To 3-1-09

3-2-07 To 3-1-08

Prior To 3-2-07

TOTALS

30% of line 12, Column A

Line 14 must be the greater of Line 12, Column B or Line 13 (See 50 IAC 4.2- 4-9)

Total True Tax Value of Depreciable Personal Property (To Summary on reverse side)

Fully depreciated assets must be included in the total cost to be reported in Schedule A above.

Filing Basics:

Effective July 1, 2015, IC 6-1.1-3-7.2 was amended to allow an exemption for taxpayers with less than $20,000 cost to be reported within a county.

Failure to timely file a personal property tax return with the applicable assessor declaring the exemption will result in a $25 penalty.

For more information, refer to this link:

To locate contact information for the various county offices (Assessor, Auditor, & Treasurer), locate forms, and learn more about Indiana’s personal

property tax system, go to Contact information for the Assessor is available at

Taxpayers may request up to a thirty (30) day extension of time to file their return. The written request should be sent to the Assessor before

the filing deadline of May 15, 2017, and should include a reason for the request. The Assessor may, at their discretion, approve or disapprove

the request in writing.

Personal property must be assessed in each taxing district where property has a tax situs.

Inventory located in the State of Indiana is exempt and is not required to be reported per IC 6-1.1-1-11(b)(3).

It is the responsibility of the taxpayer to obtain forms from the Assessor and file a timely return. The forms are also available on-line at the

department’s website,

Taxpayers may consider the ease of filing this short form versus the possible tax savings by filing Form 103-Long before choosing the form they

wish to file.

If you hold, possess, or control not-owned personal property on the assessment date, you have a liability for the taxes imposed for that year

unless you establish that the property is to be assessed to the owner. This is done by completing a Form 103-N, attaching it to the Form 103-Short,

and filing it with the Assessor. A taxpayer declaring the exemption on page one of this form may, as deemed necessary by the applicable assessor,

need to file Form 103-O or 103-N, as applicable, to verify that he is the appropriate taxpayer to claim the exemption.

NOTE: Failure to properly disclose lease information may result in a double assessment. (IC 6-1.1-2-4(a))

Taxpayers who discover an error was made on their original timely filed personal property tax return have the right to file an amended return. The

amended return must be filed within twelve (12) months of the due date or the extended due date (if up to a thirty (30) day extension was granted)

of their original return.

SECTION VI

Information of Not-Owned Personal Property which is to be assessed to the Owner

NOTE: This form is for the reporting of two or less Operating Leases. For all other leases, the Form 103-N (for the lessee) and the Form 103-O (for the

lessor) should be utilized. For more information on the reporting of leased equipment, refer to 50 IAC 4.2-8. Failure to properly disclose lease information

may result in a double assessment.

Name and Address

Location of

Date of Lease

Model Number

Cost,

Quantity

of Owner

Property

(month, day, year)

and Description

if Known