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           NOTICE OF ACTION ON EXEMPTION APPLICATION                                                                                     FORM 120
           State Form 49585 (R6 / 11-16)
           Prescribed by the Department of Local Government Finance

NOTES:     This is a notice of action on an exemption application by the County Property Tax Assessment Board of Appeals as provided
           for pursuant to IC 6-1.1-11-7.
           If you do not agree with the action of the County Property Tax Assessment Board of Appeals, the Indiana Board of Tax Review 
           will review that action if you file a timely Form 132 petition with them and provide a copy of the petition to the County Assessor. 
           This form can be located on the Indiana Board of Tax Review’s website at www.in.gov/ibtr.

Please check type of property under application:                Real                              Personal                           Both
                                                            SECTION I:  PETITIONER INFORMATION
Name of Property Owner / Petitioner (first, middle, last)

Address of Property Owner (number and street)                                        City                                   State        ZIP code

Name of Licensed Attorney 

Address of Licensed Attorney (number and street)                                     City                                   State        ZIP code

                                                            SECTION II:  DESCRIPTION OF PROPERTY
County                                             Township                                   Parcel or key number

Address of property (number and street)                                              City                                   State        ZIP code

Legal description provided on Form 11 or Property Record Card (for real property), or business name (for personal property) 

                                                            SECTION III:  FINAL DETERMINATION
You are hereby  notified that your application for a property tax exemption for the property described above has been acted upon by the
______________________________________________ County Property Tax Assessment Board of Appeals in the following manner:

       January 1, 20____ assessment date                        % Exempt                      % Taxable                                  Total

       Land

       Improvements

       Personal Property

THE COUNTY PROPERTY TAX ASSESSMENT BOARD OF APPEALS SHALL COMPLETE SECTIONS IV AND V OF THIS FORM.
See IC 6-1.1-11-7.  (Notice of action by the County Property Tax Assessment Board of Appeals; action by County Assessor and 
County Auditor; Appeal)

Date when notification was mailed (month, day, year)      Signature of County Assessor

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SECTION IV:  DETERMINATION BY COUNTY PROPERTY TAX ASSESSMENT BOARD OF APPEALS
The County Property Tax Assessment Board of Appeals’ determination is based on the following reasons.  This statement should 
include cites to applicable statutes, administrative codes or case law in support of this determination.

SECTION V:  SIGNATURES
Signature of County Property Tax Assessment Board of Appeals member               Date signed (month, day, year)

Signature of County Property Tax Assessment Board of Appeals secretary            Date signed (month, day, year)

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