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                  APPLICATION FOR MODEL RESIDENCE DEDUCTION                                                            January 1, 20___ payable in 20___ 
                  State Form 53812 (R3 / 1-16)                                                                                       For official use only 
                  Prescribed by the Department of Local Government Finance 
                   
INSTRUCTIONS:  This form is to be filed annually, by mail or in person, with the County Auditor of the county where the property is located.   
 
Filing Date:  Form must be completed and signed by December 31 and filed or postmarked by the following January 5. 
 
See page 2 for additional instructions and qualifications. 
 
                                                                APPLICANT INFORMATION 
Name of applicant                                                                      Telephone number        E-mail address 
                                                                                       (       ) 
Business address (number and street, city, state, and ZIP code)                                                                      County 

                                                                PROPERTY INFORMATION 
Address of model residence (number and street, city, state, and ZIP code) 

Brief description of residence and any other real property claimed for deduction 

Legal description                                    Key number                                              Assessed value of qualifying real property 

As of January 1, 20___, the property is:             Have you received this deduction on this property in prior years?               If yes, indicate which years 
    Partially completed             Fully completed   Yes, as partially completed                 Yes, as fully completed         No 
Deduction claimed (50% of qualifying assessed value)                                   Is the property located in an allocation area as defined by IC 6-1.1-21.2-3? 
                                                                                                                                                       Yes           No 
Are there other deductions applied to this property? If yes, please list: 
                                    Yes         No 
Have you filed for this deduction on other properties located in Indiana, either alone  
or as a member of an affiliated group?                                                        Yes        No  If yes, please list below. 
   Property Address (number and street, city, state, and ZIP code)                      Key Number / Legal Description of Property                    County 
A.                                                                                       

B.                                                                                       

C.                                                                                       

                                                                          CERTIFICATION 
I / We certify, under penalty of perjury, that the above and foregoing information is true and correct. 
Signature of applicant or authorized representative                       Printed name of applicant or authorized representative     Date signed (month, day, year) 

                                                     VERIFICATION BY ASSESSING OFFICIAL 
Is property recommended for deduction?               Assessed value of qualifying real property          Recommended deduction (50% of qualifying real property) 
                                    Yes         No 
Signature of Assessing Official                                           Printed name of Assessing Official                         Date signed (month, day, year) 

                                                     FINAL DETERMINATION OF COUNTY AUDITOR 
                                                                                                             Approved deduction 
Deduction determined by County Auditor for January 1, 20____ payable in 20____:                              $ 
Signature of County Auditor                                               Printed name of County Auditor                             Date signed (month, day, year) 

Description or reasons for change: 

Distribution on date of filing:  Original – County Auditor;  File stamped copy – Applicant;  File stamped copy – Township Assessor, if any, or County Assessor 
Distribution on date that determination is made:  Original – County Auditor;  Copy – Applicant;  Copy – Township Assessor, if any, or County Assessor 

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                                INSTRUCTIONS AND QUALIFICATIONS 
 
GENERAL INSTRUCTIONS 
 
  Applications must be filed during the periods specified. Once the application is in effect, application must be re-
   filed annually. 
    
  This application may be filed in person or by mail. If mailed, the mailing must be postmarked before the last day of 
   filing.  
    
  Any person who willfully makes a false statement of the facts in applying for this deduction is guilty of the crime of 
   perjury and on the conviction thereof will be punished in the manner provided by law. 
 
BENEFITS AND ELIGIBILITY 
 
  “Model residence” means real property that consists of a single family residence, single family townhouse, or 
   single family condominium unit that has never been occupied as a principal residence, and is used for display or 
   demonstration to prospective buyers or lessees for purposes of potential acquisition or lease of a similar type of 
   residence, townhouse, or condominium unit on the same property or other property.  
    
  Eligible applicants are entitled to a deduction from the assessed value of the residence in the amount of 50% of 
   the assessed value of the model residence for: 
    
    -       Not more than one assessment date for which the model residence is assessed as a partially completed 
            structure; 
    -       The assessment date for which the model residence is first assessed as a fully completed structure; and 
    -       The two assessment dates that immediately follow the assessment date for which the property was first 
            assessed as fully completed. 
 
LIMITATIONS 
 
  A property owner may not receive the deduction for more than three model residences in Indiana for a particular 
   assessment date. Owners of model residences who are part of an affiliated group (as defined by 50 IAC 25-2-2) 
   may not exceed an aggregate of three model residence deductions for a particular assessment date. 
    
  The owner’s regular office space is not considered a model residence for purposes of the deduction. However, 
   use of a garage or other space in a model residence to store or display promotional materials or meet with 
   prospective buyers or lessees will not disqualify the model residence from the deduction.  
    
  A property owner may not receive a model residence deduction for a model residence located in an allocation 
   area as defined in IC 6-1.1-21.2-3. 
    
  A property owner that qualifies for a model residence deduction and also qualifies for a deduction under another 
   statute with respect to the same model home for a particular assessment year may not receive a deduction under 
   both statutes for that year. 
    
  A person who owns a model residence and claims the deduction must provide the county auditor with a notice 
   that informs the auditor of a transfer of ownership of the model residence. This notice shall indicate whether the 
   new owner is eligible to receive the model residence deduction and must be submitted to the county auditor at the 
   same time that a sales disclosure form is filed under IC 6-1.1-5.5. 
    
  The deduction allowed for a model residence is terminated if the model is sold after the assessment date of a 
   particular year but before January 1 of the following year to a person who does not continue to use the property 
   as a model residence. 

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