Free 52499.pdf - Indiana

STATEMENT FOR DEDUCTION OF ASSESSED VALUATION (Investment Property Purchased by Manufacturers of Recycled Coal Combustion Products)
State Form 52499 (1-06)

March 1, 20___

Prescribed by the Department of Local Government Finance FILING DATE:

FORM PP - CCP

Must be filed between March 1 and May 15 of the year the deduction is requested. If a filing extension has been granted on a person's personal property return this form must be filed between March 1 and the extended due date. 1. This form is to be filed with the auditor of the county in which the property is located (IC 6-1.1-44-6). 2. This deduction is for manufacturers who use coal combustion by-products in the manufacture of components such as aggregates, fillers, cementitious materials individually, or in combination, to produce masonry construction products, filter media and other products approved by the Center for Coal Technology Research, Purdue University, 500 Central Drive, West Lafayette, Indiana 47907-2022. 3. A taxpayer that has obtained a credit under IC 6-3.1-25.2 may not obtain this deduction. 4. Attach proof of purchase of the investment property and proof of installation date.

INSTRUCTIONS:

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 as defined in IC 6-1.1-44
Name of taxpayer Name under which business is conducted Address where property is located (number and street, city, state, and ZIP code) Nature of business County Federal Identification number DLGF Taxing District name DLGF Taxing District number Township

Deduction Claimed: IC 6-1.1-44-3 (a)(2)(A) New business IC 6-1.1-44-3 (a)(2)(B) Existing business expanding into recycled products IC 6-1.1-44-3 (a)(2)(C) Existing business and increasing purchase of recycled product by 10% over the greatest of the prior 3 years. Complete Purchase History to the right* and attach proof for prior years.

* PURCHASE HISTORY (eg. Tons)
Current year Last year 2 years previous 3 years previous

CALCULATION OF DEDUCTION CLAIMED 1. Assessed value of the QUALIFIED INVESTMENT as reported in the first year (Depreciable Personal Property used in the manufacturing of the recycled components ­ attach list) 2. Apply percentage eligible for deduction 3. Assessed value eligible for deduction. (15% of Line 1) SIGNATURE AND VERIFICATION
I (we) hereby certify that the property is qualified for the deduction claimed and the above statements are true, correct and complete. Signature of taxpayer

$ x .15 $

Date (month, day, year)

Printed name and title

E-mail address

Telephone number ( )

I acknowledge receipt of this deduction application.

Printed name of auditor

Signature of auditor

Date (month, day, year)

RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION
Investment Property Purchased by Manufacturers of Recycled Coal Combustion Products
Name of taxpayer Signature of auditor Date filed (month, day, year) Key number Township

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.