Partnership or Joint Venture Sole Proprietorship Corporation Estate or Trust
Other (describe): _______________________________________________________________________________
PERSONAL PROPERTY RETURN
State Form 11274 (R38 / 11-19)
Prescribed by the Department of Local Government Finance
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
Signature of authorized person
Printed name of authorized person
Signature of person preparing return, if different than authorized person
Printed name and contact information of person preparing return
Under penalties of perjury, I hereby certify that this return (including any accompanying schedules and 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)
2. Location of accounting records
NAICS Code number *
Schedule A - Personal Property +
Final Assessed Value =
SUMMARY (Round all numbers to nearest ten dollars) REPORTED BY TAXPAYER CHANGE BY ASSESSOR CHANGE BY COUNTY BOARD
* NAICS - North American Industry Classification System - 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 (4) digits of that number per IC 4-1-10-3.
Page 1 of 2
JANUARY 1, 2020
For Assessor's Use Only
6. Did you own, hold, possess or control any leased, rented or other depreciable personal property on January 1?
If yes, file the Form 103-N or 103-O (See 50 IAC 4.2-8-3 and 4).
Note: Failure to properly disclose lease information may result in a double assessment.
Contact e-mail address
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.
NOTE: You must use Form 103-Long if:
a. You are a manufacturer or processor;
b. Your business personal property assessment is $150,000 or more;
c. You wish to claim any exemptions or deductions (other than the enterprise zone credit); or
d. You are claiming any special adjustments such as equipment not placed in service, special tooling,
permanently retired equipment or abnormal obsolescence.
FORM 103 - SHORT
This form contains information
confidential pursuant to IC 6-1.1-35-9.
4. Do you have other locations in Indiana?
1. Federal income tax year ends
3. Form of business
Retail merchant’s certificate number
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.
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?