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FORM 115
NOTIFICATION OF FINAL ASSESSMENT DETERMINATION
State Form 20916 (R5 / 1-09) Prescribed by the Department of Local Government Finance
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PETITION NUMBER

Co.

Dist.

Yr.

NOTES:

This is a notification of the final determination of the assessment of property as a result of the taxpayer's filing of an assessment appeal pursuant to IC 6-1.1-15-1. If you do not agree with the action of the County Property Tax Assessment Board of Appeals, the Indiana Board of Tax Review will review that action if you file a Form 131 petition with the County Assessor of this county WITHIN FORTY FIVE (45) DAYS of the mailing of this notification.

Prop. Class

Sequence

Property Class 1. Agricultural 2. Mineral Rights 3. Industrial 4. Commercial 5. Residential 6. Mobile Homes 7. Personal

Date Notification mailed (month, day, year)

Check type of property under appeal:

Real

Personal

SECTION I: TAXPAYER INFORMATION
Name of property owner (Taxpayer) (First, middle, last) Address of property owner (number and street ) Name of Authorized Representative Address of Authorized Representative (number and street ) City State ZIP code City State ZIP code

SECTION II: DESCRIPTION OF PROPERTY
County Township Parcel or Key number (for real property) City State ZIP code

Address of property (number and street )

Legal description provided on Form 11 or Property Record Card (for real property) , or business name (for personal property)

SECTION III: FINAL DETERMINATION
Effective date of assessed value Land: Assessed Value determined as a result of the filing of Form 130 Improvements: Personal Property/Deductions: $ $

MARCH 1, 20_____

$

You are hereby notified that the assessed value of the property described on this notification is determined to be the value stated above as of March 1. This determination is made as a result of: Preliminary informal meeting between the taxpayer and the Assessor (attach Form 134 ) Note: Additional assessor comments may be included in Section IV of this form. County Property Tax Assessment Board of Appeals hearing (Complete Sections V, VI, and VII)

Form 115, page 1

SECTION IV ADDITIONAL ASSESSOR COMMENTS AFTER THE PRELIMINARY INFORMAL MEETING IS HELD AND THE FORM 134 IS FILED

SECTION IV: ADDITIONAL INFORMATION SUPPORTING THE RESOLUTION REACHED AT THE PRELIMINARY INFORMAL MEETING This section may be used by the Assessor to provide additional information or clarification to the County Property Tax Assessment Board of Appeals that was not included in the "Assessor's Comments" section on the Form 134 (Joint Report on Preliminary Informal Hearing) where there was an agreement on all issues:

Signature of Assessor

Date signed (month, day, year)

SECTIONS V, VI, AND VII ARE COMPLETED ONLY IF HEARING IS HELD BY PROPERY TAX ASSESSMENT BOARD OF APPEALS

SECTION V: DETERMINATION BY COUNTY PROPERTY TAX ASSESSMENT BOARD OF APPEALS The determination of the County Property Tax Assessment Board of Appeals is justified for the following reasons:

Form 115, page 2

SECTION VI: RECORD OF HEARING Date of Hearing: _______________________________________ County Property Tax Assessment Board of Appeals members present: ______________________________________ ______________________________________ ______________________________________ Persons present on behalf of taxpayer: ______________________________________ ______________________________________ Persons (include titles) present on behalf of Assessor: ______________________________________ ______________________________________ ______________________________________ ______________________________________

Taxpayer's exhibits: ______________________________________________________________________________________________ _______________________________________________________________________________________________________________ Assessor's exhibits: ______________________________________________________________________________________________ _______________________________________________________________________________________________________________ County Property Tax Board of Appeals exhibits: ________________________________________________________________________ _______________________________________________________________________________________________________________ SECTION VII: PROPERTY VIEWING Date of property viewing: _______________________________________ County Property Tax Assessment Board of Appeals members present: ______________________________________ ______________________________________ ______________________________________ Persons present on behalf of taxpayer: ______________________________________ ______________________________________ Persons (include titles) present on behalf of Assessor: ______________________________________ ______________________________________ ______________________________________ ______________________________________

Statement of additional evidence gathered by County Property Tax Assessment Board of Appeals at property viewing and considered: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________

Signature of County Property Tax Assessment Board of Appeals member Signature of County Property Tax Assessment Board of Appeals secretary

Date signed (month, day, year) Date signed (month, day, year)

Form 115, page 3