STATE FORM 53915 (R2 / 12-22)                                                                                                          TREASURER FORM TS-1P 
APPROVED BY STATE BOARD OF ACCOUNTS, 20  19                                                       PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE, IC 6-1.1-22.5-8 

                                         SPECIAL MESSAGE TO PROPERTY OWNER 
________ County has elected to send provisional tax statements. This is not your final bill. When you receive your final bill, it will 
include a detailed comparison statement. This provisional bill is based on your bill last year. Property taxes are constitutionally 
capped at 1% of property values for homesteads (owner-occupied), 2% for other residential property and agricultural land, and 
3% for  all other property. Please note  that local government unit annual budget notices are now available online at: 
https://budgetnotices.in.gov. Additional information for how to read you current tax bill can be located online at: 
www.in.gov/dlgf/understanding-your-tax-bill/tax-bill-101. 
                                            TAXPAYER AND PROPERTY INFORMATION 
         Taxpayer Name                   Property Address     Date of Notice                               Parcel Number           Taxing District  
         A1                                 A2                                        A3                   A4                          A5 

                                                         Space reserved for county data purposes. 

Spring installment due on or before May 10, 2023, and Fall installment due on or before November 13, 2023. 
                                         TABLE 1: SUMMARY OF YOUR PROVISIONAL TAXES                                 
ASSESSED VALUE AND TAX SUMMARY                                                                                                           2022 Pay 2023 
1. Total gross assessed value of property for 2022                                                                                              1A1 
1a. Minus deductions                                                                                                                            1B1 
2. Total net property tax due last year                                                                                                         1C1 
2a. Minus local property tax credits                                                                                                            1D1 
2b. Minus savings due to property tax cap (see Table 2 and footnotes below)                                                                     1E1 
2c. Minus savings due to over 65 circuit breaker credit                                                                                         1F1 
3. Total provisional property tax liability (see remittance coupon for total amount due)                                                        1G1 

                                            TABLE 2: PROPERTY TAX CAP INFORMATION                              
Property tax cap (1%, 2%, or 3% depending upon combination of property types)  1                                                                2A1 
Upward adjustment due to voter-approved projects and charges (e.g., referendum)  2                                                              2B1 
Maximum tax that may be imposed under cap                                                                                                       2C1 
Under Indiana law, _________County has elected to send provisional statement because the county did not complete the abstract of the property, assessments, taxes, deductions, and exemptions 
for taxes payable in __________ (insert date).  The statement is due to be paid in installments on __________ (insert date) and __________ (insert date). The first installment is equal to fifty 
percent (50%) of your tax liability for taxes payable in __________ (insert year), subject to adjustment to the tax liability authorized by the department of local government finance and approved 
by the county treasurer. The second installment is either the amount specified in a reconciling statement that will be sent to you, or (if a reconciling statement is not sent until after the second 
installment is due) an amount equal to fifty percent (50%) of your tax liability for taxes payable in __________ (insert year), subject to adjustment to the tax liability authorized by the department 
of local government finance and approved by the county treasurer. After the abstract of the property is complete, you will receive a reconciling statement in the amount of your actual tax liability 
for taxes payable in 2023, minus the amount you pay under this provisional statement. 
1. The property tax cap is calculated separately for each class of property owned by the taxpayer.
2. Charges not subject to the property tax cap include property tax levies approved by voters through referendum. When added to the base property tax cap amount for your property, this 
creates the effective tax cap. For more information, see the back of this documents. Information regarding the referendums proposed during the most recent elections can be located online at:
www.in.gov/dlgf/referendum-information. 

COUNTY: XX – NAME                                                                                 SPRING INSTALLMENT REMITTANCE COUPON 
         PARCEL NUMBER                   COUNTY PARCEL NUMBER                                     TAX YEAR 
                                                                                                                         Late Payment Penalty: 5% penalty 
xx-xx-xx-xxx-xxx.xxx-xxxTAXING UNIT NAME xx-xx-xx-xxx-xxx.xxx-xxxLEGAL DESCRIPTION2022 Payable 2023                      after May 10, 2023, if there is no 
                                                                                                                         delinquent amount; 10% penalty for 
                                         XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                            previous delinquency or if payment is 
                                         XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX                                            made after June 9, 2023. 

                                                                                                  TOTAL AMOUNT DUE 
                              (Bar Code)                                                                                           $XXX.XX 
                                                                                                  By May 10, 2023: 

                                                                                                           Office Phone: (XXX) XXX-XXXX 
                                                                                                           Pay Online at: (Website) / (Phone) 
Property Owner Name  
Mailing Address                                                                                            Remit Payment and Make Check Payable to: 
Mailing City, State Zip Code                                                                               XXXXX County Treasurer  
                                                                                                           Address 
                                                                                                           Treasurer City, State Zip Code 
(OCR Code) 

STATE FORM 53915 (R2 / 12-22)                                                                                                           TREASURER FORM TS-1P 
APPROVED BY STATE BOARD OF ACCOUNTS, 2022                                           PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE, IC 6-1.1-22.5-8 
 
                                               PROVISIONAL PROPERTY TAX ASSESSMENTS 
 
 Name and Address of Taxpayer   – The owner and mailing address of the owner of record as of the date of this notice. 
 Date of Notice – The date the provisional notice is sent to property owner. 
 Property Number (State) and (Local/Duplicate) – State mandated property number followed by locally assigned property number. 
 Taxing District – The number assigned by the Department of Local Government Finance to the taxing district in which this property is located. 
 
                                          TABLE 1: SUMMARY OF YOUR PROVISIONAL TAXES 
 
 Tax Summary Item – The amounts involved with calculating your real estate property taxes. 
 Gross Assessed Value for 2022 – The gross assessed value of the property in 2022, used to calculate the base property tax cap (see below). 
 Total Net Property Tax Due Last Year – The base amount for adjustment calculations based on one hundred percent (100%) of the 2021-Pay-2022 tax 
 liability. 
 Adjustment for Property Tax Cap - For the purposes of this provisional statement, the cap is calculated based on assessed valuation of this property for 
 the 2022 tax year; therefore, the cap may change when values for tax year 2023 are approved.  
 Over 65 Circuit Breaker Credit – Credit for a calendar year if homestead qualifies and age, adjusted gross income, homestead assessed value, and other 
 eligibility requirements are met. The credit caps the increase of property tax liability at 2%. 
 Total Provisional Property Tax – The total provisional amount due for this property after all adjustments applicable to this property have been made. 
 Your payment for the provisional bill is ½ of this amount; the remainder will be due after the final bill is calculated. 
 
                                               TABLE 2: PROPERTY TAX CAP INFORMATION 
                                                                              
 Property Tax Cap – Property may not be taxed above caps prescribed by law, unless voters approve additional taxes. These caps are 1% for homesteads, 
 2% for other residential property and agricultural land, and 3% for all other classes of property. When voters approve additional spending in a referendum, 
 an adjustment to the cap is made to reflect the additional expense. This excess revenue is calculated as a separate value and added to the cap figure. This 
 new value is considered your effective property tax cap or the maximum that may be imposed under the cap. Taxpayers should note that the circuit 
 breaker cap amount is the combined cap amount for all classes of property applicable to a parcel. 
  
 Information on the valuation of your property and a copy of the property record card can be obtained from your assessor at (___) ____-_________ or  
 http://www.____________________  . Property taxes billed on the provisional tax bill are due and payable in the same manner as property taxes billed on 
 a regular tax bill under Ind. Code § 6-1.1-22-8.1, and will be credited against a reconciling tax bill. All payments of property taxes shall be made to the 
 county treasurer. Indiana Code § 6-1.1-15 (Procedures for Review and Appeal of Assessment), does not apply to a provisional tax bill; thus, no appeal 
 may be filed from a provisional tax bill. The interest and penalty provisions apply to a provisional tax bill. The penalty is equal to an amount determined 
 as follows: (1) if an installment of real property taxes is completely paid on or before thirty (30) days after the due date; and (2) the taxpayer is not liable 
 for delinquent property taxes from a previous installment for the same parcel ;the amount of the penalty is equal to five percent (5%) of the amount of 
 delinquent taxes. If the real property taxes are not completely paid on or before thirty (30) days after the due date, the amount of the penalty is equal to ten 
 percent (10%) of the amount of delinquent taxes. 
  
                                          SPACE RESERVED FOR COUNTY PAYMENT INFORMATION