Schedule A - Personal Property +
Deduction per Form 103 ERA or Form 103-CTP -
Final Assessed Valuation =
If taxpayer answers "yes" to question 5, the owner must file Form 103-O and the possessor must file Form 103-N. Failure to properly disclose lease information may result in a
double assessment. (See 50 IAC 4.2-2 and 50 IAC 4.2-8).
Failure to file a return on or before the due date as required by law will result in the imposition of a twenty-five dollar ($25) penalty. In addition, if the return is not filed within
thirty (30) days after such return is due, a penalty equal to twenty percent (20%) of the taxes finally determined to be due with respect to the property which should have been
reported will be imposed. A personal property return is not due until the expiration of any extension period granted by the Township Assessor or County Assessor under IC
6-1.1-3-7(b). If the total assessed value that a person reports on a personal property return is less than the total assessed value that the person is required by law to report
and if the amount of the undervaluation exceeds five percent (5%) of the value that should have been reported on the return, then the County Auditor shall add a penalty of
twenty percent (20%) of the additional taxes finally determined to be due as a result of the undervaluation.
In completing a personal property return for a year, a taxpayer must make a complete disclosure of all information relating to the value, nature, or location of personal property
owned, held, possessed or controlled on the assessment date. (IC 6-1.1-3-9(a)). This information would include, but not be limited to, completion of the heading and related
information, answers to all questions on the face of the return, and entries on all of the appropriate lines of Schedule A. If such information is not provided, the taxpayer will be
contacted and directed to provide that information. In addition, a penalty of $25 shall be imposed. (IC 6-1.1-37-7(d))
* NAICS - North American Industry Classification System - A complete list of codes may be found at www.census.gov.
NOTE: The NAICS Code Number appears on your federal income tax return.
** An individual using his Social Security Number as the Federal Identification Number is only required to provide the last four digits of that number. IC 4-1-10-3.
1. Federal income tax year ends __________________________
Name filed under _________________________________________________
2. Location of accounting records ____________________________________________________________________________________________
3. Form of business
Partnership or Joint Venture Sole Proprietorship Corporation Estate or Trust
Other, describe: ___________________________________________________________________________
4. Do you have other locations in Indiana? Yes No
5. If property is in more than one location, what is the address for the location where the sum of acquisition costs for the property is greatest?
6. Did you own, hold, possess or control any leased, rented or other depreciable personal property on January 1? Yes No (See 50 IAC 4.2-8)
7. Did you own, hold, possess or control any Special Tools on January 1? Yes No
(See 50 IAC 4.2-6-2)
8. Did you own, hold, possess or control any returnable containers on January 1? Yes No
(See 50 IAC 4.2-6-4)
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
Name and address to which Assessment and Tax Notice are to be mailed (If different than above)
Federal identification number **
DLGF taxing district number
DLGF taxing district name
Retail merchant’s certification number
Signature of authorized person
Name and title of authorized person (please type or print)
Signature of person preparing return, if different than authorized person
Under penalties of perjury, I hereby certify that this return (including any accompanying schedules, deduction claims, or statements), to the best of my
knowledge and belief, is true, correct, and complete; if applicable, reports all tangible personal property subject to taxation owned, held, possessed or
controlled by the named taxpayer in the stated township or taxing district on the assessment date, as required by law; and is prepared in accordance
with IC 6-1.1 et seq., as amended, and regulations promulgated with respect thereto.
SIGNATURE AND VERIFICATION
Date (month, day, year)
SUMMARY (Round all numbers to nearest ten dollars)
REPORTED BY TAXPAYER
CHANGE BY ASSESSOR CHANGE BY THE COUNTY BOARD
NAICS Code number *
BUSINESS TANGIBLE PERSONAL
PROPERTY ASSESSMENT RETURN
State Form 11405 (R42 / 11-19)
Prescribed by the Department of Local Government Finance
1. Please type or print.
2. This form must be filed with the Township Assessor, if any, or the County Assessor of the county in which the property is located not later than May 15, 2020,
unless an extension of up to thirty (30) days is granted in writing. Contact information for the Assessor is available at http://www.in.gov/dlgf/2440.htm.
3. A Form 104 must be filed with this return.
JANUARY 1, 2020
For Assessor's Use Only
Page 1 of 4
Name and contact information of preparer (please type or print)
NOTE: For taxpayers with less than $40,000 in acquisition costs to report within the county, legislation was passed in 2019 which exempts this property. If
you are declaring this exemption, check this box, enter the total acquisition cost of your personal property in the county, and complete only sections I, II, and
IV of this form. If you are declaring this exemption through this form, you also need to file a Form 104.
RETURN THIS FORM TO THE APPLICABLE ASSESSOR BY MAY 15, 2020.
An exemption granted under IC 6-1.1-10 or any other statute supersedes this exemption. In other words, a taxpayer whose personal property is exempt
because the taxpayer applied for and was granted an exemption by the county must follow all applicable procedures for the approved exemption, which
may include fully completing the personal property return.
FORM 103 - LONG
This form contains information
confidential pursuant to IC 6-1.1-35-9.