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                STATEMENT FOR DEDUCTION OF ASSESSED VALUATION                                                                                                    FORM SES / WPD
                (Attributed to Solar Energy System or Solar, Wind, Geothermal, or Hydroelectric Power Device)
                State Form 18865 (R12 / 1-20)
                Prescribed by the Department of Local Government Finance
INSTRUCTIONS:  To be filed in person or by mail by the owner of such property with the County Auditor of the county in which the property is located.
                 A person who is no longer eligible for this deduction shall notify the County Auditor of this change.  (IC 6-1.1-12-36)
FILING DATES:    (1) Must be completed and dated by December 31 of the year for which the person wishes to obtain the deduction and filed or postmarked
                 on or before January 5 of the calendar year in which the property taxes are first due and payable.
                 (2) State Distributable Property under IC 6-1.1-8 (solar powered device only):  Must be completed and dated by December 31 of the year
                 for which the person wishes to obtain the deduction and filed on or before January 5 of the following calendar year.
                 (3) Personal Property under IC 6-1.1-3 (solar powered device only):  Must be completed and dated by December 31 of the year for which
                 the person wishes to obtain the deduction and filed on or before January 5 of the following calendar year.  In addition to filing this form
                 for the deduction, an applicant must also attach a Form 103-SPD to either his personal property tax return or his amended personal
                 property tax return for each year the deduction is desired.
                 (IC 6-1.1-12-26; 6-1.1-12-26.1; 6-1.1-12-27.1; 6-1.1-12-29; 6-1.1-12-30; 6-1.1-12-33; 6-1.1-12-34; 6-1.1-12-35.5; 6-1.1-12-36)
All claims for a deduction filed on a geothermal or hydroelectric system or device must be accompanied by proof of certification of qualification by the 
Department of Environmental Management pursuant to IC 6-1.1-12-35.5.
                                                               CERTIFICATION STATEMENT
  I (We), _________________________ certify that I (we) own or am (are) buying on contract or am (are) leasing the real property from the real property 
  owner the following real property, mobile/manufactured home, state distributable property, or personal property that is subject to assessment and 
  property taxation and for which a:
               Solar Energy Heating or Cooling System          Wind Power Device         Geothermal Device               Hydroelectric Device
         Solar Power Device*:            Real       Mobile/Manufactured Home             State Distributable               Personal Property
     *Applies to a solar power device installed after December 31, 2011.
  deduction from assessed valuation is hereby claimed in __________________________________________________________ county.      
Date system/device was installed (month, day, year)                                      Total deduction claimed
                                                                                         $

                                                                PROPERTY DESCRIPTION
Taxing District (city, town, township)                Township                                                    Legal description or key number

If a deduction was allowed last year, have there been any changes in the property?                                Parcel number
                                                                                   Yes No
Address of owner (number and street, city, state, and ZIP code)

I (We) hereby certify that the above statement is     Signature                                                   Date (month, day, year) 
true, correct, and complete.
                                                                                                                        Assessment Date First Effective
                                       FOR AUDITOR'S USE ONLY                                                                 20 ____ Payable 20 ____
1    Total assessed value of real property or mobile / manufactured home including qualifying device / system.         $
2(a) For wind; geothermal; hydroelectric; real property or mobile / manufactured home with a solar powered device:
     Enter the assessed valuation without the qualifying device / system.
2(b) For solar energy system only:  Out-of-pocket expenditures for components and installation labor.
2(c) For personal property solar power device deduction:  Enter amount calculated on Form 103-SPD.
2(d) For state distributable solar power device deduction:  Enter assessed value of qualifying equipment.
3    Deduction:  Line 1 minus Line 2(a); or enter the actual amount shown on Line 2(b), 2(c), or 2(d).
                                                               VERIFICATION BY ASSESSING OFFICIAL
Is property recommended for deduction?                Recommended deduction              Comments, if any
                                       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 assessment date of _______________ , 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