Form 115 - Notification Of Final Assessment Determination
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3NOTIFICATION OF FINAL ASSESSMENT DETERMINATION
FORM 115
State Form 20916 (R3 / 11-98)
Prescribed by the State Board of Tax Commissioners
PETITION NUMBER
NOTES:
This is a notification of the final determination of the assessment of
property by the County Property Tax Assessment Board of Appeals
__ __ - __ __ __ - __ __ - 0 - __ - __ __ __ __ __
as provided for pursuant to IC 6-1.1-15-2.1.
Co.
Yr.
Prop.
Sequence
Dist.
Class
If you do not agree with the action of the County Property Tax Assessment
Board of Appeals, the State Board of Tax Commissioners will review that
Property Class
action if you file a Form 131 petition with the County Assessor of this county
5. Residential
WITHIN THIRTY (30) DAYS of the mailing of this notification.
1. Agricultural
2. Mineral Rights
6. Mobile Homes
7. Personal
Pursuant to IC 6-1.1-15-3, your appeal to the State Board of Tax Commissioners is
3. Industrial
limited to the issues determined as a result of the County Property Tax Assessment
4. Commercial
Board of Appeals review.
Date Notification mailed (month, day, year)
Check type of property under appeal:
Real
Personal
SECTION I: PETITIONER INFORMATION
Name of property owner (Petitioner) (first, middle, last)
City
State
Address of property owner
ZIP code
Name of Authorized Representative
City
State
Address of Authorized Representative
ZIP code
SECTION II: DESCRIPTION OF PROPERTY
County
Township
Parcel or Key number (for real property)
Address of property
City
State
ZIP code
Legal description provided on Form 11 or Property Record Card (for real property), or business name (for personal property)
SECTION III: FINAL DETERMINATION
Effective date of assessed value
Assessed Value determined by County Property Tax Assessment Board of Appeals
Land:
Improvements:
Personal Property:
$
$
$
MARCH 1, __________________
You are hereby notified that the County Property Tax Assessment Board of Appeals has determined the assessed value of the property described on this
notification to be the value stated above as of March 1. THE COUNTY PROPERTY TAX BOARD OF APPEALS SHALL COMPLETE SECTION IV, V
AND VI OF THIS FORM. This notice shall be mailed to both the taxpayer and authorized representative. Copies of this determination shall be
forwarded to the County Assessor, Township Assessor, and County Auditor.
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