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                    APPLICATION FOR DEDUCTION FROM ASSESSMENT 
                                                                                                                                                 20___ PAY 20___
                    ON REHABILITATED DWELLINGS
                    State Form 49568 (R7 / 11-16)
                    Prescribed by the Department of Local Government Finance                                                                            FORM  322

SPECIAL NOTE:     No new deductions for the rehabilitation of residential property under IC 6-1.1-12-18 may be granted after the January 1, 2017 
                              assessment date.
County                                                          Township                                                     DLGF taxing district number

 The undersigned owner hereby applies to the County Auditor pursuant to IC 6-1.1-12-18 through 20, for a deduction from the assessed value on the 
 following residential property for a period of five (5) years, first available on January 1, 20____ and the following four (4) years.
Name of owner                                             Address of property (number and street, city, state, and ZIP code)  
                                                                                                              
Number of dwelling units on the property                                                Number of dwelling units rehabilitated                           
                                                                                                               
                                                         LEGAL DESCRIPTION AS FOUND ON TAX DUPLICATE
Section                                         Township                                Range                                           Addition

Lot number                                                      Block number                                                 Key or parcel number

               TYPE OF                           ASSESSMENT                    ASSESSMENT                             DIFFERENCE                 INCREASE IN
               DWELLING                          AFTER                         PRIOR TO                               IN ASSESSED                       A/V DUE TO
                                                REHABILITATION                 REHABILITATION                             VALUE                  REHABILITATION *
1. Single Family

2. Two Family
3. Three or More Family
    (Number of Units________)
 * The assessed value (A/V) eligible for the deduction is the increase in A/V resulting from the rehabilitation and does not include the increase in A/V which
 resulted from the reassessment of the entire property (land and improvements).
                                                                             CERTIFICATION
 I hereby certify that the representations on this application are true.
Signature of owner                                              Name of owner (print or type)                                            Date (month, day, year)
                                                                                                        
Address (number and street, city, state, and ZIP code)

Township                                                                                County                                                                     
                                                                                                       
                                                                              VERIFICATION
Assessment after rehabilitation                                                         Assessment prior to rehabilitation

        Type of Family Dwelling:                                                        Amount of deduction approved *
    Single Family                     Two Family                    Three or More Family
Signature of township assessor if any, or county assessor                               Signature of county auditor                     

 1. Application must be filed with the county auditor in person or by mail in the year in which the addition to the assessed value is made.  If notice of the 
    addition to assessed value is not given to the property owner before December 1 of that year, this form may be filed not later than thirty (30) days after 
    the date of the mailing of the notice.
 2. Limitation on availability:  The assessed valuation of the property prior to rehabilitation (excluding exemptions or deductions) cannot exceed $37,440 
    for single family dwellings; $49,920 for a two (2) family dwelling; or $18,720 per dwelling unit for three (3) or more family units.  The applicant must 
    also own the property or is buying it under contract on the assessment date of the year in which this form is filed.
 3. The deduction in assessed value allowable cannot exceed the lesser of  $18,720 per rehabilitated dwelling unit or the total increase in assessed value 
    resulting from the rehabilitation (*).  A general reassessment or a cyclical reassessment which occurs within the five (5) year period of the deduction 
    does not affect the amount of the deduction.  (IC 6-1.1-12-18 and IC 6-1.1-12-19)
 4. The county auditor must present the application to the assessor of the township in which the property is located for verification of the deduction.  Upon 
    receiving verification, the county auditor shall make the deduction.  (IC 6-1.1-12-20(e))