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       PETITION FOR REVIEW OF ASSESSMENT 
       BEFORE THE INDIANA BOARD OF TAX REVIEW                                                                                              FORM 131
       State Form 42936 (R9 / 9-15) / IBTR Form 131                                                                                        IBTR PETITION NUMBER
       Prescribed by the Indiana Board of Tax Review

INSTRUCTIONS:         1.  Complete all sections of this petition.                                           __  __   --   __  __  __   --   __  __  --  1  --  __  --   __  __  __  __  __   --   __  __
                      2.  File this petition with the:                                                              Co.              Dist.  Appeal           Prop. Sequence    Year 
                      Indiana Board of Tax Review                                                                                             Year           Class             Filed
                      100 North Senate Avenue, Room N-1026
                      Indianapolis, IN 46204
                      3.  Mail a copy of this petition to the other party.  

FILING INFORMATION
Information regarding appeal procedures is available on the Indiana Board of Tax Review (IBTR) website located at www.in.gov/ibtr.
FILING DEADLINE:  This petition must be filed not later than forty-five (45) days after the Notification of Final Assessment Determination is given to the
taxpayer.  If the maximum time period for the county board to hold a hearing or to give notice of its determination has passed, the Petitioner may initiate an
appeal to the IBTR.
ATTACHMENTS TO THIS PETITION:  The following information must be attached to this petition.
  1.  A copy of the written notice, Form 130 (State Form 21513), or Form 130-Short (State Form 53958) filed to initiate this appeal.
  2.  A copy of the Notification of Final Assessment Determination (State Form 20916 / Form 115).  The Form 115 is not required if the maximum time period
       for the county board to act has passed, or if there is a Standard Form Agreement (State Form 55853) waiving a determination by the county board.
  3.  The petition must be signed by the Petitioner or an authorized representative.  A representative must attach a notarized power of attorney unless the
       representative is an attorney licensed to practice law in Indiana, or a duly authorized employee or corporate officer of the taxpayer.
  4.  Certified Tax Representatives must attach a Tax Representative Disclosure Statement. 
  5.  A listing of other related parcels that are currently on appeal.
Multiple years, multiple parcels, or multiple types of property (real and personal) require separate petitions, except that a party may ask the
IBTR for permission to file a single petition for multiple parcels where the parcels are contiguous and the issues to be appealed on each parcel are 
substantially similar.
FAILURE TO FOLLOW INSTRUCTIONS:  The Petitioner must complete all sections of this petition.  If the Petitioner does not comply with the instructions 
for completing this form, the IBTR may return the petition to the Petitioner with a description of the defect.  The Petitioner will then have thirty (30) days from
the date of the notice of defect to cure the defect and file a corrected petition.  If the corrected petition does not comply with the instructions for completing the
form, the IBTR may deny the petition. 
Type of appeal (check only one ):         Real Property               Personal Property                     Deduction     Credit                       Other - Explain in Section 3.
Is this property currently under appeal with the Indiana Board of Tax Review for another tax year?                                              Yes            No
If yes, indicate year(s) and type of appeal(s): _____________________________________________________________________
Is this a direct appeal to the IBTR?  Yes                   No     If yes, indicate the reason for appealing directly to the IBTR.
           The maximum time period for the county board to act has passed.
           Agreement to waive the county board determination.  Standard Form Agreement (State Form 55853) must be attached.

                                      SECTION  1:  PROPERTY AND PETITIONER INFORMATION
County                Township                                              Parcel or Key number (for real property)

Address of property (number and street or rural route)                                                      City                                          ZIP Code

Legal description provided on Form 11 or Property Record Card (for real property) , or business name (for personal property)                       Assessment year under appeal
                                                                                                                                                           __________________
Petitioner Name                                                                     Telephone Number                  E-mail Address
                                                                                     (           )
Petitioner Address (number and street or rural route)                               City                                                   State          ZIP Code

Name of authorized representative (if different from Petitioner)                    Telephone Number                  E-mail Address
                                                                                     (           )
Address of authorized representative (number and street or rural route)             City                                                   State          ZIP Code

                                                        SECTION  2:  SMALL CLAIMS OPTION
  If the assessed value of the property does not exceed $1,000,000, the petition is subject to the small claims rules.  The Petitioner may elect to opt-out of
  the small claims rules and be subject to the more formal standard procedural rules.  Before making the election, please review both the small claims rules
  (52 IAC 3) and the more formal standard procedural rules (52 IAC 2) available on the IBTR website.
       ACCEPT SMALL CLAIMS                             Initial                                              OPT-OUT OF SMALL CLAIMS                                Initial

                                                                            Form 131, page 1Form 131, page 1

                                                                                                                         SECTION  3:  GROUNDS FOR APPEAL
                                                                                                                              Year on Appeal                                              Prior Year
 Real Property
                                                                                                                         Land                            Improvements              Land                              Improvements
  Original Tax Notice [Form 11]                                                                                           $ $ $ $
  County Board Determination [Form 115]                                                                                   $ $ $ $
  Petitioner's Claim                                                                                                      $ $

 Personal Property                     Assessment of Record [Form 115]                                                    $                                  Petitioner's Claim          $

  For All Appeals:  Please explain in detail the basis of your belief that the assessed value is incorrect.

                                           SECTION  4:  OPTIONAL ELECTION OF ELECTRONIC SERVICE
  I elect to receive all notices regarding this petition by electronic mail.  I understand that the electronic mail notices are considered effective in the same
  manner as if the notices had been sent by United States mail to the party's mailing address of record and a hard copy will not be provided.
  Elect electronic service                                 Initial                                                             Email address for service

                                                                                                                         SECTION  5:  SIGNATURES
 PETITIONER, TAXPAYER, OR DULY AUTHORIZED EMPLOYEE OR CORPORATE OFFICER OF THE TAXPAYER
 I certify that all entries on this form are accurate to the best of my knowledge and belief.  
Signature of petitioner taxpayer or duly authorized officerSignature of petitioner, taxpayer, or duly authorized officer                                   Date signed Date signed (month day year)(month, day, year)

Printed or typed name of petitioner, taxpayer, or duly authorized officer                                                                                  Title (please print or type)

 TAX REPRESENTATIVE
 I certify that all entries on this form are accurate to the best of my knowledge and belief.  I certify that I have the authority to file this form and
 that I have made all necessary disclosures to my client, pursuant to 52 IAC 1-2-2
Signature of tax representative                                                                                                                            Date signed (month, day, year)

Printed or typed name of tax representative

 ATTORNEY REPRESENTATIVE
 I certify that all entries on this form are accurate to the best of my knowledge and belief.
Signature of attorney representative                                                                                                                       Date signed (month, day, year)

Printed or typed name of attorney representative                                                                                                           Attorney number

                                                                                                                         SECTION 6:  CERTIFICATE OF SERVICE
In addition to filing this petition with the IBTR, a copy of this petition must be mailed to the Respondent.  In most cases, the Respondent is the county assessor.
If this petition is filed by the county assessor, then the taxpayer is the Respondent.  Complete the date of service, the name and address of the party being
served, the manner of service, and then sign and date.

  I affirm under the penalties of perjury that on this  __________ day of __________________, 20_____, a copy of this petition has been served on:
 Name:                                                                                                                                                     Manner of service:
 Address:                                                                                                                                                              US Mail
                                                                                                                                                                       Hand delivery
                                                                                                                                                                       Other
 
                     Signature                                                                                                                             Date (month, day, year)

                                                                                                                         Form 131, page 2Form 131, page 2