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               NOTICE OF ASSESSMENT / CHANGE
               BY AN ASSESSING OFFICIAL                                                                                        ASSESSMENT DATE
               State Form 21521 (R12 / 10-19)                                              FORM 113 / PP                       ____________ 1, 20____
               Prescribed by the Department of Local Government Finance

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 not later than forty-five (45) days after the 
date of this notice of assessment. (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.
NOTE: Failure to file a timely Form 130 can be grounds for dismissal of this appeal.
Name of taxpayer

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

You are hereby notified that the undersigned assessing official has taken the action described below with regard to the following property:
                                                                         LOCATION OF PROPERTY
County                                                       Township                                         Taxing district

Address where property is located (number and street, city, and ZIP code)

                                                                      DESCRIPTION OF PROPERTY
Farmer's Personal Property (Form 102)                                             Business Personal Property (Form 103)
Public Utility Company Distributable Property (Form UD45) (deductions only)

                                                                           ACTION
Assessed value before deductions has been changed from $ ________________________ to $ ________________________ .
Assessed value of a deduction was changed from $ ________________________ to $ ________________________ . 
Failure to file required assessment return. Assessment has been estimated to be $ ___________________________________ .
Other (explain) _________________________________________________________________________________________________________
                        _________________________________________________________________________________________________________

                                                                         REASON(S) FOR ACTION
Failure to file required assessment return.  You have the right to file an assessment return within thirty (30) days of the first notice of assessment, 
subject to the penalties imposed by IC 6-1.1-37-7. (50 IAC 4.2-3.1-2)
               Mathematical error (describe below)                                Omitted property (describe below)
Mandatory or allowable adjustment not properly computed or disallowed (describe and state below)
               Abnormal obsolescence adjustment disallowed (be sure to specify reason(s))
Exemption disallowed (describe and give reasons):                        In-whole       In-part
               Industrial waste control equipment not certified by                Air pollution control equipment not qualified
               Department of Environmental Management
Other __________________________________________________________________________________________________________________
Description or reasons (attach additional sheet if necessary)

Date of this notice (month, day, year)                                            Name (please print)

Telephone number                       Title                                      Signature
(             )
Address (number and street, city, state, and ZIP code)