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STATEMENT FOR DEDUCTION OF ASSESSED VALUATION (Fertilizer and Pesticide Storage Improvements)
State Form 45651 (R5 / 7-08)

Prescribed by the Department of Local Government Finance

FILING DATE: Must be filed prior to June 10th of the year preceding the year the deduction will first be applied.
INSTRUCTIONS: All claims for deduction must be filed with the county auditor and accompanied by Proof of Certification of qualifying improvements obtained from the State Chemist. Direct written request for Proof of Certification along with drawings illustrating improvements complete with dimensions, height and thickness of walls, materials, tank locations, contents and capacities, in addition to documents to verify work done, i.e., statements and bills from contractors builders and suppliers, to: Office of Indiana State Chemist, Purdue University 175 S. University St. West Lafayette, Indiana 47907-2063 Attributed to improvements made concerning pesticide and fertilizer storage, to comply with 355 IAC 5 and / or 355 IAC 2.

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 _____ for which a deduction from assessed valuation is hereby claimed.

PROPERTY DESCRIPTION
Taxing district Address of owner (number and street, city state, and ZIP code) Township Legal description or key number

I (we) hereby certify that the above statement is true, correct and complete:
Signature of owner Date (month, day, year)

FOR AUDITOR'S USE ONLY
1. Assessed valuation AFTER improvements made: 2. MINUS: Assessed valuation at 100% of TTV BEFORE improvements made: 3. DIFFERENCE: INCREASE in assessed valuation: 4. Assesed valuation elgible for deduction:
Signature of auditor Name of assessing official (please print name) Signature of assessing official Date (month, day, year) $ $ $

0.00

$
Date (month, day, year)

I hereby verified that the above statements are found to be true and correct.
Title of assessing official

RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION
Fertilizer and Pesticide Storage Improvement Deduction
Name of owner Description of property in county Signature of auditor Township Legal description or key number 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.