Free 53179.FH11 - Indiana

APPLICATION FOR DEDUCTION FROM ASSESSED VALUATION REAL PROPERTY VACANT BUILDING DEDUCTION
State Form 53179 (1-07) Prescribed by the Department of Local Government Finance

20____ PAY 20____ FORM 322 / VBD

INSTRUCTIONS: 1. This form is for assessments on March 1, 2007 and after. 2. This form is to be filed with the county auditor of the county in which the real property is located. 3. This form must be filed between March 1, and May 10, of the filing year unless an extension of up to thirty (30) days is granted in writing. 4. The building must have been unoccupied for at least one (1) year prior to filing this application and zoned for commercial or business use. 5. A copy of the approved Form SB-1 / Real Property, resolution from the designating body, and Form CF-1 / Real Property must be attached to this application. 6. 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 IC 6-1.1-12.1-4.8. 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 Is this property within an Economic Revitalization District (ERA)? Is this property within a Tax Increment Financing (TIF) district 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 vacant building deduction as outlined in IC 6-1.1-12.1-4.8.
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

EFFORTS TO SELL OR LEASE VACANT BUILDING

Describe efforts by the owner to sell, lease, or rent the building during period of vacancy

Show amount for which the building was offered for sale, lease, or rent during period of vacancy

SECTION 4 ASSESSED VALUE 01 02 Year 1 Year 2 3-1-20____ 3-1-20____ $ $

FOR USE BY COUNTY AUDITOR PERCENT DEDUCTION X X 100% 50% = = DEDUCTION APPROVED (for use by County Officials) $ $ DEDUCTION DENIED (for use by County Officials) $ $
Date of approval (month, day, year)

Signature of Township Assessor