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State Form 49567 (R4 / 7-08)

APPLICATION FOR DEDUCTION FROM ASSESSED VALUATION OF REHABILITATED PROPERTY

FORM 322A

Prescribed by the Department of Local Government Finance

BUILDINGS OR STRUCTURES ONLY, ERECTED AT LEAST 50 YEARS PRIOR TO THIS APPLICATION
County Township DLGF taxing district number

The undersigned owner hereby applies to the County Auditor, pursuant to IC 6-1.1-12-22 through IC 6-1.1-12-24, for a deduction from the increase in assessed valuation resulting from rehabilitation of the following described property:
Address of property (number and street or rural route) Year building or structure originally erected City Date of rehabilitation (month, day, year) State Cost of rehabilitation ZIP code

Type of dwelling:

Single family dwelling Other
Township Block number

Kind of rehabilitation:

Significant repairs Improvements
Addition Key or parcel number

Replacements

LEGAL DESCRIPTION AS FOUND ON TAX DUPLICATE
Section Lot number Range

(IMPROVEMENTS ONLY) ASSESSMENT AFTER REHABILITATION

(IMPROVEMENTS ONLY) ASSESSMENT (at 100% of TTV) PRIOR TO REHABILITATION

INCREASE DUE TO REHABILITATION

DEDUCTION ON ASSESSMENT CLAIMED

0.00
Application must be filed in person or by mail with the County Auditor prior to May 10 in the year in which Addition to Assessed Valuation is made OR not later than 30 days after the date of mailing of assessment notice by assessor, if such notice is not given prior to April 10. [IC 6-1.1-12-24 (a) and (b)] I hereby certify that the representations on this application are true.
Signature of owner Address (number and street) Printed name of owner (print or type) City, state, and ZIP code Date (month, day, year)

VERIFICATION BY ASSESSING OFFICIAL
1. Type of structure 2. Date erected (month, day, year) 3. Date rehabilitated (month, day, year) 4. Date reassessed (month, day, year) 5. Date taxpayer notified of increase in assessed valuation (month, day, year) 6. Assessed valuation of improvements AFTER rehabilitation 7. Assessed valuation at 100% of TTV of improvements PRIOR TO rehabilitation 8. Amount of INCREASE attributed to rehabilitation 9. Date verified (month, day, year)

REDUCTION CALCULATION BY AUDITOR
1. Amount of INCREASE attributed to rehabilitation (Same as #8 on left) 2. 50% of #1 above

0.00
3. Maximum annual deduction (For single family dwellings - taxes due and payable prior to 1/1/05 $60,000; after 1/1/05 $124,800. For other structures - $300,000.)

4. Annual deduction (Lesser of #2 or #3) 5. Date deduction approved (month, day, year) 6. First year of deduction (Year in which taxes on rehabilitated portion of property became payable.)

7. Fifth year of deduction

NOTE: Owner must have paid at least $10,000 for the rehabilitation. General reassessment during the deduction period does not affect the amount of the deduction. (IC 6-1.1-12-23)
Signature of assessing official (or trustee) Signature of county auditor