STATEMENT FOR DEDUCTION OF ASSESSED VALUATION 
                 (Fertilizer and Pesticide Storage Improvements) 
                 State Form 45651 (R9 / 9-24) 
                 Prescribed by the Department of Local Government Finance 
FILING DATE:         Form must be completed, signed, and filed or postmarked by January 15 of the immediately succeeding calendar year. 
INSTRUCTIONS: 
All claims for deduction must be filed with the county auditor and accompanied by Proof of Certification of qualifying improvements obtained from the State Chemist. 
Direct written request for Proof of Certification along with drawings illustrating improvements complete with dimensions, height and thickness of walls, materials, 
tank locations, contents and capacities, in addition to documents to verify work done, i.e., statements and bills from contractors, builders, and suppliers, to:  
Office of Indiana State Chemist, Purdue University 
175 S. University St. 
West Lafayette, Indiana 467907-2063 
Attributed to improvements made concerning pesticide and fertilizer storage, to comply with 355 IAC 5 and / or 355 IAC 2. 
                                                                 CERTIFICATION STATEMENT 
STATE OF INDIANA 
                                       SS: 
COUNTY OF __________________ 

I (We), _________________________________________________________________________ certify that I (we) own the following described property 
for which a deduction from assessed valuation is hereby claimed.  

                                                                 PROPERTY DESCRIPTION 
Taxing District (city, town, township)        Township                                                     Legal Description or Key Number 

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

I (We) hereby certify that the above statement is true, correct, and complete. 
Signature of Owner                                                                                         Date (month, day, year) 

                                                                 FOR AUDITOR’S USE ONLY 
1. Assessed valuation AFTER improvements made:                                                                 $ 

2. MINUS: Assessed valuation at 100% of TTV BEFORE improvements made:                                          $ 

3. DIFFERENCE: INCREASE in assessed valuation:                                                                 $                                                  0.00

4. Assessed valuation eligible for deduction:                                                                  $ 
Signature of Auditor                                                                                       Date (month, day, year) 

                                                                               Name of Assessing Official (please print name) 
I hereby verify that the above statements are true and correct. 
Title of Assessing Official                                                    Signature of Assessing Official            Date (month, day, year) 

                                       RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION 
                                              Fertilizer and Pesticide Storage Improvement Deduction 
Name of Owner 

Description of Property in County                                                                                         Legal Description or Key Number 

Signature of Auditor                                                           Township                                   Date Filed (month, day, year) 

Pursuant to IC 6-1.1-37-3, a person commits a Level 6 felony if the person makes and subscribes a property tax return, statement, or document (except a 
statement described in IC 6-1.1-37-4 or 5) that the person does not believe is correct in every material respect and the return, statement, or document is 
certified to as to the truth of the information appearing in it.