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APPLICATION FOR DEDUCTION FROM ASSESSED VALUATION REAL PROPERTY INVESTMENT DEDUCTION
State Form 52504 (R3 / 1-09) Prescribed by the Department of Local Government Finance

MARCH 1, 2009 FORM RPID-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 filed with the township assessor of the township in which the real property is located. 3. This form must be filed not later than thirty (30) days after mailing date of notice of assessment (Form 11) showing the new or increased assessment. 4. A copy of the Form 11 must be attached to this application. 5. A separate form must be filed each year the deduction is requested. 6. 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). 7. The total amount of a real property investment deduction cannot exceed two million dollars ($2,000,000) in any one county. This is calculated from the Total Deduction Line in Section 3, which includes the allowable investment deduction for all years. 8. 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. 9. This deduction is subject to 50 IAC 22 and IC 6-1.1-12.4. 10. 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 j. Package liquor store IC 6-1.1-12.1-2(c)(1 & 2) 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 DLGF Taxing District number Name of contact person Parcel number

PROPERTY INFORMATION

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SECTION 2

REQUEST FOR DEDUCTION AND DESCRIPTION OF BENEFIT TO TAXING JURISDICTION

Describe the real property investment

Total cost of the real property investment (include all hard and soft costs) 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 certify that the above named taxpayer is liable for property taxes at the above listed location on the indicated assessment date and that the representations on this application are true and correct. I further certify that the real property investment identified above is eligible for the real 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

FOR USE BY TOWNSHIP ASSESSOR TRUE TAX VALUE OF THE INVESTMENT PERCENT DEDUCTION X 75% X 50% X 25% DEDUCTION APPROVED (for use by County Officials) = = = not applicable not applicable $
Total deduction approved

DEDUCTION DENIED (for use by County Officials) not applicable not applicable $
Total deduction denied

01 02 03

Year 1 Year 2 Year 3

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

not applicable not applicable $

Signature of Township Assessor

Date of approval (month, day, year)