NOTICE OF ASSESSMENT OF LAND AND STRUCTURES / IMPROVEMENTS                                                                FORM 11 
        State Form21366 (R2 1/ 11-23) 
        Prescribed by the Department of Local Government Finance 

                                                                                           THIS IS NOT A TAX BILL 
                        County Contact/Address 
                                                                                                 APPEAL DEADLINE IS: 
                                                                                                                [Appeal Deadline] 

                                                                                                                QR Code 

                   Name and Address of Property Owner 

                                                                                                 Scan the QR code for access to 
                                                                                                                your property record card. 

Legal Description                                                                          Parcel or Identification Number 

Property Address (number and street, city, state, and ZIP code) 

This notice indicates the assessed value of your property. Information on the valuation of your property and a copy of the property record card can be obtained 
from the assessing official at the telephone number and address below. 
Notice to the taxpayer of the opportunity to appeal (IC 6-1.1-15-1.1, 1.2): 
If the taxpayer does not agree with the action of the assessing official giving this notice, an appeal can be initiated to challenge that action. To file an appeal, the 
taxpayer must file a Form 130, Taxpayer's Notice to Initiate an Appeal, with the township assessor or county assessor in a timely manner. The time-frame to file 
an appeal on the assessment contained in this notice may have two different filing deadlines. These deadlines are based on the date that this notice is mailed. If 
this notice is mailed before May 1 of the assessment year, the filing deadline is June 15 of that year. If this notice is mailed on or after May 1 of the assessment 
year, the filing deadline is June 15 in the year that the tax statements are mailed. (IC 6-1.1-15-1.1) This form is available from the assessing official or at: 
https://forms.in.gov/Download.aspx?id=6979. An assessing official who receives a Form 130 must schedule a preliminary informal meeting with the taxpayer in 
order to resolve the appeal. The assessing official and taxpayer must exchange the information each party is relying on at the time of the preliminary informal 
meeting to support the party's respective position on each disputed issue concerning the appeal. If the taxpayer has reason to believe that the township 
assessor, county assessor, an employee of the township assessor or county assessor, or an appraiser has violated IC 6-1.1-35.7-3 or IC 6-1.1-35.7-4(a), the 
taxpayer may submit a written complaint to the Department of Local Government Finance under IC 6-1.1-35.7-4(b). 
NOTE: Failure to file a timely Form 130 can be grounds for dismissal of this appeal. 

                   PREVIOUS ASSESSMENT                                               NEW ASSESSMENT EFFECTIVE JANUARY 1, 20______ 
LAND                                                                        LAND 
STRUCTURES/                                                                 STRUCTURES/ 
IMPROVEMENTS *                                                              IMPROVEMENTS * 
TOTAL                                                                       TOTAL 
Reason for Revision of Assessment: 

If the change in assessment is due to a new home, a taxpayer should be aware that there are many property tax benefits or deductions available. Please see 
INDIANA PROPERTY TAX BENEFITS (State Form 51781) available on the DLGF website: www.IN.gov/dlgf. Other non-residential construction may be eligible for 
deductions - see Forms 322/RE and Form 322/VBD.  
County                                                          Township                                        Date of Notice (month, day, year) 

Assessing Official                                                                         Telephone Number 
                                                                                           (       ) 
Address (number and street, city, state, and ZIP code)