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                                                                                           FORM  103-T                 JANUARY 1, 20 ______
               RETURN OF SPECIAL TOOLS                                                     PRIVACY NOTICE              For assessing officials only
               State Form 22667 (R10 / 11-16)                                   This form contains information 
               Prescribed by the Department of Local Government Finance         confidential pursuant to IC 6-1.1-35-9.

INSTRUCTIONS: Attach and file with Form 103 Long.
Name of owner (please print or type)                                                                                   County

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

                                                    REPORT OWNED SPECIAL TOOLS ON THIS SIDE 
     SECTION I                       INCLUDE  - TOOLS, DIES, JIGS, PATTERNS, FIXTURES, ETC., OWNED                           SCHEDULE I
LINE Round all figures to the nearest dollar.
1    Total Cost of special tools, dies, jigs, etc. (50 IAC 4.2-6-2)                                                              $
           NOTE: Divide Total Cost on Line (1) above into two categories as noted below.                                          TRUE TAX VALUE
2    CATEGORY I      Total Cost (Acquisitions since last assessment date)                   $                          X  30% =  $
3    CATEGORY II     Total Cost (Acquisitions prior to last assessment date)                $                          X    3% = $
4    Total True Tax Value, Special Tools - to Form 103, Section A, Line 56
                                                                                                                                 $

                                                    SECTION II - ASSESSED TO OWNER ON FORM 103
Information return of all special tools owned and reported for assessment on Form 103 as of January 1 of the current assessment year by this taxpayer 
but which were held, possessed, or controlled by another person. (Attach list if necessary.)
NAME AND ADDRESS OF PERSON           LOCATION                       DATE OF                            DATE DELV'D                COST PER
  POSSESSING PROPERTY                OF PROPERTY    MANUFACTURE                            DESCRIPTION TO POSSESSOR    QUANTITY   50 IAC 4.2

                                                                                                               TOTAL

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  FORM 103-T                                                                    SCHEDULE II                             JANUARY 1, 20 ______
                                          REPORT SPECIAL TOOLS POSSESSED BUT NOT OWNED ON THIS SIDE
                                          INCLUDE - TOOLS, DIES, JIGS, PATTERNS, FIXTURES, ETC., NOT OWNED
Name of person in possession of property (please print or type)                                                         County

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

LINE Round all figures to the nearest dollar.
1    Total Cost of special tools, dies, jigs, etc. not owned  (if known)50(     IAC 4.2-6-2)                            $

                                                                ASSESSED TO OWNER ON FORM 103
Information return of all special tools not owned by this taxpayer but which were held, possessed, or controlled by this taxpayer as of January 1 of the 
current assessment year and that are to be reported for assessment on Form 103 by the owner. (Attach list if necessary.)
     NAME AND ADDRESS                     LOCATION                DATE OF                              DATE                     COST PER
     OF OWNER                             OF PROPERTY             MANUFACTURE              DESCRIPTION ACQUIRED        QUANTITY 50 IAC 4.2

                                                                                                       TOTAL

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