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APPLICATION FOR DEDUCTION FROM ASSESSED VALUATION PERSONAL PROPERTY INVESTMENT DEDUCTION
State Form 52502 (R3 / 1-09) Prescribed by the Department of Local Government Finance

March 1, 2009 FORM PPID-1

PRIVACY NOTICE: The records in this series are CONFIDENTIAL according to IC 6-1.1-35-9. INSTRUCTIONS: 1. This form is for assessments on March 1, 2006, but before March 2, 2007. 2. This form is to be made part of the taxpayers personal property return. 3. This form must be filed with the taxpayers personal property return. 4. A separate form must be filed each year a deduction is requested. 5. This deduction may not be used in conjunction with any abatement or in an allocation area as defined in IC 6-1.1-21.2-3 (TIF district). 6. The total amount of a personal property investment deduction cannot exceed two million dollars ($2,000,000) in any one county. 7. To obtain a deduction, the taxpayer must show how the investment will increase assessed value and create jobs or retain employees in the taxing jurisdiction pursuant to the definitions in 50 IAC 22. 8. This deduction is subject to 50 IAC 22 and IC 6-1.1-12.4. 9. An investment deduction is not authorized for any of the following types of facilities (See IC 6-1.1-12.1-3(e)): a. Private or commercial golf course k. Any facility, the primary purpose of which is: b. Country club 1) retail food and beverage service c. Massage parlor 2) automobile sales or service d. Tennis court 3) other retail, unless the facility is located in an economic development target e. Skating facility, including roller or ice skating area established under IC 6-1.1-12.1-7. or skateboarding l. Residential, unless the facility is: f. Racquet sport facility including handball 1) a multifamily facility that contains at least 20% of the units available or racquet ball courts for low and moderate income individuals; g. Hot tub facility 2) located in an economic development target area established under h. Suntan facility IC 6-1.1-12.1-7; or i. Racetrack 3) designated as a residentially distressed area under IC 6-1.1-12.1-2 j. Package liquor store (C)(1 & 2) 10. If the 30% floor is applicable for the True Tax Value, the Investment Deduction will be calculated in accordance with the Minimum Value Ratio memo (see the memo at http://www.in.gov/dlgf/pdfs/260-2006-051006.pdf). SECTION 1
Address of property (number and street, city, state, and ZIP code) County Name of owner Mailing address of owner (number and street, city, state, and ZIP code) Telephone number Fax number E-mail address (optional) Township Name of contact person DLGF Taxing District number

PROPERTY DESCRIPTION

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SECTION 2

REQUEST FOR DEDUCTION AND DESCRIPTION OF BENEFIT TO TAXING JURISDICTION

Describe the personal property investment

Total cost of the personal property investment as shown in the Adjusted Cost column of Schedule A of the personal property return Is this property within an Economic Revitalization District (ERA)? Is this property within an allocation area as defined in IC 6-1.1-21.2-3?

Yes

No

Yes

No

I hereby verify under penalty of perjury that the above named taxpayer is liable for property taxes on the above described personal property on the indicated assessment date and that the representations on this application are true and correct. I further verify under penalty of perjury that the personal property investment identified above is eligible for the personal property investment deduction as outlined in 50 IAC 22 and IC 6-1.1-12.4
Signature of owner or representative (if representative, attach power of attorney) Printed name of signatory Title Date signed (month, day, year) Telephone number of preparer

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SECTION 3 TRUE TAX VALUE OF THE INVESTMENT not applicable not applicable $

CALCULATION OF DEDUCTION PERCENT DEDUCTION X 75% X 50% X 25% DEDUCTION CLAIMED (for use by taxpayer) = = = not applicable not applicable $
Total deduction claimed

DEDUCTION APPROVED (for use by County Officials) not applicable not applicable $
Total deduction approved

01 02 03

Year 1 Year 2 Year 3

3-1-2009 3-1-2008 3-1-2007

Signature of Township Assessor

Date of approval (month, day, year)