Form 103 (Short) - Business Tangible Personal Property Return

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BUSINESS TANGIBLE

MARCH 1, 2015

FORM

PERSONAL PROPERTY RETURN

For Assessor's Use Only

103 - SHORT

State Form 11274 (R32 / 11-14)

PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE

PRIVACY NOTICE: The records in

this series are confidential according

to IC 6-1.1-35-9.

INSTRUCTIONS:

PLEASE TYPE or PRINT.

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 unless an extension of up to thirty (30) days is granted in writing. Contact information for the Assessor is available at

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.

Name of taxpayer

Federal Identification number **

Name under which business is conducted

DLGF taxing district number

Address where property is located (number and street, city, state, and ZIP code)

DLGF taxing district name

Nature of business

T ownship

Name and address to which Assessment and T ax Notice is to be mailed (If different than above)

County

NAICS * Code number

1. Federal Income T ax Year ends

Retail merchants certificate number

2. Location of accounting records

3. Form of business

Partnership or Joint Venture

Corporation

Other, (describe)

Estate or Trust

Sole Proprietorship

4. Do you have other locations in Indiana?

5. Did you own, hold, possess or control any leased, rented or other depreciable personal property on March 1?

If yes, report it on Page 2 or file the Form 103-N or 103-O (See 50 IAC 4.2-8-3 & 4).

Yes

Note: Failure to properly disclose lease information may result in a double assessment.

6. T otal sales for this location during the prior fiscal or calendar year

SUMMARY (Round all numbers to nearest ten dollars)

REPORTED BY TAXPAYER

CHANGE BY ASSESSOR

CHANGE BY COUNTY BOARD

Schedule A - Personal Property

Final Assessed Value

SIGNATURE AND VERIFICATION

Under Penalties of Perjury, I hereby certify that this return (including accompanying schedules and statements), to the best of my knowledge and belief,

is true, correct, and complete; 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 of this return, as required by law; and is prepared in accordance with I.C. 6-1.1 et seq.,

as amended, and regulations promulgated with respect thereto.

Signature of authorized person

Date (month, day, year)

Printed name of authorized person

T elephone number

Title

(

)

Signature of person preparing return, if different than authorized person

Contact e-mail address

Printed name and contact information of person preparing return

* NAICS - North American Industry Classification System - complete list of codes may be found at .

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.

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