Petition For Review Of Assessment Before The Indiana Board Of Tax Review (Page 2 of 2) in pdf

SECTION 3: GROUNDS FOR APPEAL

Year on Appeal

Prior Year

Real Property

Land

Improvements

Land

Improvements

Original Tax Notice [Form 11]

County Board Determination [Form 115]

Petitioner's Claim

Personal Property

Assessment of Record [Form 115]

Petitioner's Claim

For All Appeals: Please explain in detail the basis of your belief that the assessed value is incorrect.

SECTION 4: OPTIONAL ELECTION OF ELECTRONIC SERVICE

I elect to receive all notices regarding this petition by electronic mail. I understand that the electronic mail notices are considered effective in the same

manner as if the notices had been sent by United States mail to the party's mailing address of record and a hard copy will not be provided.

Elect electronic service

Initial

Email address for service

SECTION 5: SIGNATURES

PETITIONER, TAXPAYER, OR DULY AUTHORIZED EMPLOYEE OR CORPORATE OFFICER OF THE TAXPAYER

I certify that all entries on this form are accurate to the best of my knowledge and belief.

Date signed (month day year)

Date signed (month, day, year)

Signature of petitioner taxpayer or duly authorized officer

Signature of petitioner, taxpayer, or duly authorized officer

Printed or typed name of petitioner, taxpayer, or duly authorized officer

Title (please print or type)

TAX REPRESENTATIVE

I certify that all entries on this form are accurate to the best of my knowledge and belief. I certify that I have the authority to file this form and

that I have made all necessary disclosures to my client, pursuant to 52 IAC 1-2-2

Date signed (month, day, year)

Signature of tax representative

Printed or typed name of tax representative

ATTORNEY REPRESENTATIVE

I certify that all entries on this form are accurate to the best of my knowledge and belief.

Date signed (month, day, year)

Signature of attorney representative

Printed or typed name of attorney representative

Attorney number

SECTION 6: CERTIFICATE OF SERVICE

In addition to filing this petition with the IBTR, a copy of this petition must be mailed to the Respondent. In most cases, the Respondent is the county assessor.

If this petition is filed by the county assessor, then the taxpayer is the Respondent. Complete the date of service, the name and address of the party being

served, the manner of service, and then sign and date.

I affirm under the penalties of perjury that on this __________ day of __________________, 20_____, a copy of this petition has been served on:

Name:

Manner of service:

Address:

US Mail

Hand delivery

Other

Signature

Date (month, day, year)

Form 131, page 2