STATEMENT FOR DEDUCTION OF ASSESSED VALUATION                                                                          Reset Form
                (Fertilizer and Pesticide Storage Improvements)
                State Form 45651 (R8 / 10-15)
                Prescribed by the Department of Local Government Finance
FILING DATE:         Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
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 47907-2063
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                                                              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)

Any person commits a Level 6 felony if he (she) makes and subscribes a property tax return statement or document that he (she) does not believe is 
correct in every material respect pursuant to I.C. 6-1.1-37-3.