Free 52500.FH11 - Indiana

Reset Form

STATEMENT FOR DEDUCTION FROM ASSESSED VALUATION BUILDING CONSTRUCTED OF COAL COMBUSTION PRODUCTS
State Form 52500 (R3 / 7-08)

FORM RE-CCP

Prescribed by the Department of Local Government Finance FILING DATE: Must file the statement during the twelve (12) months before June 11 of the assessment year. (IC 6-1.1-12-35.5)

INSTRUCTIONS: 1. This form is to be filed in duplicate with the auditor of the county in which the property is located. (IC 6-1.1-12-34.5) 2. The deduction is for buildings that are constructed from at least 60% dry weight in recycled coal combustion products. A component is considered recycled if at least 15% (by weight) of the component is made from coal combustion products such as boiler slag, bottom ash, fly ash and scrubber sludge. (IC 6-1.1-44) 3. Direct written request for Proof of Certification along with drawings illustrating improvements complete with dimensions, height and thickness of walls and materials in addition to documents to verify work done, i.e., statements and bills from contractors builders and suppliers, to: Purdue University - Office of Center for Coal Technology Research, 500 Central Drive, West Lafayette, Indiana 47907-2022. 4. Attach a copy of the Certification of Qualifying Building obtained from the Center for Coal Technology Research. If unavailable, attach copy of request including supporting documents. CERTIFICATION STATEMENT STATE OF INDIANA, COUNTY OF ________________________________________________________________ , SS: I (We), __________________________________ certify that I (we) own the following described property on the 1(st) day of March, 20 _____ and the property is eligible for a deduction to the assessed valuation under IC 6-1.1-12-34.5 as is hereby claimed.

PROPERTY DESCRIPTION
Taxing district (city, town, township) Address of property / legal description Address of owner (number and street, city, state, and ZIP code) DLGF taxing district number Parcel or key number

I (we) hereby certify that the above statement is true, correct and complete:
Signature of taxpayer Printed name and title E-mail address Date (month, day, year) Telephone number

(

)

FOR AUDITOR'S USE ONLY 1. Assessed value of QUALIFIED BUILDING 2. Apply percentage eligible for deduction 3. Assessed value eligible for deduction. (5% of Line 1) 4. Deduction is applicable for 3 years beginning and carrying forward through I acknowledge receipt of this deduction application.
Signature of auditor Printed name of auditor Date (month, day, year)

$ x .05 $ pay pay pay

0.00

RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION Buildings Constructed of Coal Combustion Products
Name of owner Description of property in county Signature of auditor Parcel or key number Township Date filed (month, day, year)

Any person commits a class D felony if he (she) makes and subscribes a property tax return statement or document that he (she) does not believe is correct in every material respect pursuant to I.C. 6-1.1-37-3. Actions by the Assessing Official, County Property Tax Board of Appeals or the Department of Local Government Finance that result in a denial of this deduction may be appealed under the procedures specified in IC 6-1.1-15.