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                                                                                                                                            FORM 115
                        NOTIFICATION OF FINAL ASSESSMENT DETERMINATION                                                       PETITION NUMBER
                       State Form 20916 (R8 / 12-18)
                      Prescribed by the Department of Local Government Finance
                                                                                                       __  __ --  __  __  __ --  __  __ --  --  __ --  __  __  __ 0__  __

                                                                                                         Co.      Dist.      Yr.        Prop.                            Sequence
NOTES:    ●           This is a notification of the final determination of the assessment of                                                     Class
                      property as a result of the taxpayer's filing of an assessment appeal
                      pursuant to IC 6-1.1-15-1.1.
                                                                                                                                        Property Class
                  ●If you do not agree with the action of the County Property Tax Assessment
                   Board of Appeals, you may petition the Indiana Board of Tax Review (IBTR).               1. Agricultural                                 5. Residential
                   In order to obtain a review by the IBTR, an individual must, not later than              2. Mineral Rights          6. Mobile Homes
                   FORTY-FIVE (45) DAYS  after the date of this notice, file a petition for review          3. Industrial                                   7. Personal
                  with the IBTR (Form 131) and mail a copy of the petition to the County Assessor.          4. Commercial

 Date Notification mailed (month, day, year)                                   Check type of property under appeal:                   Real                              Personal

                                                          SECTION I:  TAXPAYER INFORMATION
 Name of property owner (Taxpayer) (first, middle, last)

 Address of property owner (number and street )                                 City                               State                            ZIP code

 Name of Authorized Representative (if different from taxpayer)                        Representative appointed by the taxpayer.
                                                                                       Representative required to complete State Form 23261, Power of Attorney.
 Address of Authorized Representative (number and street )                      City                               State                            ZIP code

                                                          SECTION II:  DESCRIPTION OF PROPERTY
 County                           Township                                      Parcel or Key number (for real property)

 Address of property (number and street )                                       City                               State                            ZIP code

 Legal description provided on Form 11 or Property Record Card (for real property), or business name (for personal property)

                                                          SECTION III:  FINAL DETERMINATION
 Effective date of assessed value                             Assessed Value determined as a result of the filing of Form 130
                                              Land:                             Improvements:                                     Personal Property/Deductions:   
 JANUARY 1, 20_____                           $                                 $                                                 $

    You are hereby notified that the assessed value of the property described on this notification is determined to be the value stated 
    above as of January 1.  This determination is made as a result of:               Preliminary informal meeting between the taxpayer and the
                                                                                     Assessor (attach Form 134)

                                                                                     Note:  Additional assessor comments may be included in  
                                                                                     Section IV of this form.

                                                                                     County Property Tax Assessment Board of Appeals hearing
                                                                                     (Complete Sections V, VI, and VII)

                                                                           Page 1 of 3

SECTION IV ADDITIONAL ASSESSOR COMMENTS AFTER THE PRELIMINARY INFORMAL MEETING IS HELD AND THE FORM 
                                                    134 IS FILED

SECTION IV:  ADDITIONAL INFORMATION SUPPORTING THE RESOLUTION REACHED AT THE PRELIMINARY INFORMAL MEETING
This section may be used by the Assessor to provide additional information or clarification to the County Property Tax Assessment
Board of Appeals that was not included in the "Assessor's Comments" section on the Form 134 (Joint Report on Preliminary Informal 
Hearing where there was an agreement on all issues):

 Signature of Assessor                                                                          Date signed (month, day, year)

SECTIONS V, VI, AND VII ARE COMPLETED ONLY IF HEARING IS HELD BY PROPERTY TAX ASSESSMENT BOARD OF 
                                                    APPEALS

     SECTION V:  DETERMINATION BY COUNTY PROPERTY TAX ASSESSMENT BOARD OF APPEALS

TheThdetermination of the County Property Tax Assessment Board of Appeals is justified for the following reasons:e determination of the County Property Tax Assessment Board of Appeals is justified for the following reasons:

                                                    Page 2 of 3

                                                                          SECTION VI:  RECORD OF HEARING

  Date of Hearing (month, day, year) : _________________________________________

  County Property Tax Assessment Board of Appeals members present:

  ______________________________________________________                              ________________________________________________

  ______________________________________________________                              ________________________________________________

  ______________________________________________________

  Persons present on behalf of taxpayer:                                                        Persons (include titles) present on behalf of Assessor:

  ______________________________________________________                              _______________________________________________

  ______________________________________________________                              _______________________________________________

  Taxpayer's exhibits: __________________________________________________________________________________________

 ___________________________________________________________________________________________________________

  Assessor's exhibits: __________________________________________________________________________________________

 ___________________________________________________________________________________________________________

  County Property Tax Assessment Board of Appeals exhibits: _________________________________________________________

 ___________________________________________________________________________________________________________

                                                                          SECTION VII:  PROPERTY VIEWING

  DaDate of property viewingte(m(monthof propertyday year)onth,viewing: : _____________________________________day, year)

  County Property Tax Assessment Board of Appeals members present:

  ______________________________________________________                              ________________________________________________

  ______________________________________________________                              ________________________________________________

  ______________________________________________________

  Persons present on behalf of taxpayer:                                                        Persons (include titles) present on behalf of Assessor:

  ______________________________________________________                              ________________________________________________

  ______________________________________________________                              ________________________________________________

  Statement of additional evidence gathered by County Property Tax Assessment Board of Appeals at property viewing and considered:

  ______________________________________________________________________________________

  ______________________________________________________________________________________

  ______________________________________________________________________________________

 Signature of County Property Tax Assessment Board of Appeals member                                                      Date signed (month, day, year)

 Signature of County Property Tax Assessment Board of Appeals secretary                                                   Date signed (month, day, year)

                                                                                    Page 3 of 3