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             APPLICATION FOR DEDUCTION FROM ASSESSED                                                                                      JANUARY 1, 2018
                                                                                                           FORM MOD - 1
             VALUATION - MARITIME OPPORTUNITY DISTRICT                                                                                For official use only
             State Form 42963 (R7 / 10-17)                                                                 PRIVACY NOTICE
             Prescribed by the Department of Local Government Finance                                      This form contains 
                                                                                                           information confidential  
                                                                                                           pursuant to IC 6-1.1-35-9.

                                                                                 INSTRUCTIONS
 1.  This form is to be filed with the auditor of the county in which the property is located and with the Department of Local Government Finance. (IC 6-1.1-40-11)
 2.  This form is filed between January 1 and May 15 of the year for which the person reports the property for assessment. (IC 6-1.1-40-11) 
 3.  Attach a copy of the current year and immediately preceding year Business Personal Property Assessment Returns (Form 103 - Long).
 4.  If this is the first year for claiming this deduction, attach copy of designation by Indiana Port Commission.
 5.  Attach a copy of the Statement of Benefits (Form SB-1/PP) approved by the Indiana Port Commission. (IC 6-1.1-40-9)
 6.  Attach a copy of the Compliance with Statement of Benefits (Form CF-1/PP) or the Benefit Performance Waiver Certificate issued by the Indiana Port 
   Commission. (IC 6-1.1-40-12,13)
 7.  Attach a copy of the Certificate of Export Sales for previous year as certified by the Indiana Department of Revenue.
 8.  Attach a list of the qualifying equipment reported in Section I of Schedule A showing the date installed, cost, and a description of the asset. This list is confidential.

 Name of taxpayer

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

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

 Taxing district number             Taxing district name                         Township                          County

                                                                 DISTRICT INFORMATION
 Name of Indiana port                                            Date district was designated (month, day, year)  Date designation will expire, if any (month, day, year)

                                                                 DEDUCTION CLAIMED
 TOTAL MARITIME OPPORTUNITY DISTRICT DEDUCTION FOR NEW MANUFACTURING EQUIPMENT
  (Schedule A of this form)                                                                                                          $
 I, as the owner or authorized representative, hereby certify that the above named taxpayer is liable for business personal property tax on the above property 
 at the location listed on the indicated assessment date. I also certify that: (1) on the assessment date, the property was located in a Maritime Opportunity 
 District designated by the Indiana Port Commission; and (2) that the taxpayer is entitled to the deduction above. 
Signature of taxpayer                                                                       Title                                    Date (month, day, year)

                                    DO NOT WRITE HERE - FOR USE BY DEPARTMENT OF LOCAL GOVERNMENT FINANCE
 This application has been reviewed by the Department of Local Government Finance and the following determination made:

 Assessment Date:   January 1, 20______                                          Approved amount of deduction:            $__________________
 Description or reason for action:

 Notice to the taxpayer of the opportunity to appeal this determination (IC 6-1.1-14-11):
 A taxpayer may initiate an appeal of the department’s final determination by filing a petition with the Indiana Board of Tax Review not more than forty-five 
 (45) days after the Department gives the taxpayer notice of the final determination.
 Signature of Commissioner                                                                                                           Date (month, day, year)

DISTRIBUTION: Original - Department of Local Government Finance                  Duplicate - County Auditor
                        100 North Senate Avenue, Room N1058
                        Indianapolis, IN  46204

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PRIVACY NOTICE: This form contains information confidential pursuant to IC 6-1.1-35-9.
                                                                    SCHEDULE A
                            MARITIME OPPORTUNITY DISTRICT - DEDUCTION FOR NEW MANUFACTURING EQUIPMENT
Name of contact person                      Telephone number                                                  E-mail address
                                            (            )

SECTION I                   THIS SECTION MUST ONLY INCLUDE ELIGIBLE EQUIPMENT INSTALLED BETWEEN
                               THE PRIOR ASSESSMENT DATE AND THE CURRENT ASSESSMENT DATE
1. SHOW QUALIFIED CURRENT YEAR ACQUISITIONS ONLY                                                       COST CLAIMED  TRUE TAX VALUE
   A. POOL No.1, Line 13 (See special instruction 4 below.)
   B. POOL No. 2, Line 18 (See special instruction 4 below.)
   C. POOL No. 3, Line 26 (See special instruction 4 below.)
   D. POOL No. 4, Line 38 (See special instruction 4 below.)
2. TOTAL POOL TRUE TAX VALUE (Add A through D)                                                                                                  $
3. OTHER (TTV OF CURRENT YEAR “SPECIAL TOOLING”)                                                                    $
4. TOTAL TRUE TAX VALUE (TTV) (Line 2 plus Line 3)                                                                                              $
5. ASSESSED VALUE. (Round Line 4 to the nearest $10)                                                                                            $
6. ASSESSED VALUE OF LINE 60 SCHEDULE A OF CURRENT YEAR FORM 103-LONG                                               $
7. ASSESSED VALUE OF LINE 64 SCHEDULE A OF PRIOR YEAR FORM 103-LONG
8. LIMIT ON AMOUNT OF ABATEMENT (Line 6 [-] Line 7)See(     special instruction 6 below.     )
9. AMOUNT OF DEDUCTION CLAIMED (Lessor of Line 5 or 8 - Carry this amount to Section II, Year 1 below)                                          $

SECTION II                  SUMMARY OF CLAIMS (Prior year’s approved claims as adjusted, plus current year’s claim)
                               Assessed Value of                                                              Indicate for the years below whether that year’s 
                                                                 Times
            Assessment         Qualifying Equipment                                                           deduction was based on the actual assessed 
                                                                 Deduction                   Deduction Claimed
                       Year    (See special instruction                                                       value (Actual A/V) or the Limit described in 
                                                            Percentage
                               6 for Abatement Limits.)                                                       special instruction 6 below.
   Year 1   January 1, 2018                                      100%                                         Check one:                        Actual A/V                    Limit
   Year 2   January 1, 2017                                      100%                                         Check one:                        Actual A/V                    Limit
   Year 3   January 1, 2016                                      100%                                         Check one:                        Actual A/V                    Limit
   Year 4   March 1, 2015                                        100%                                         Check one:                        Actual A/V                    Limit
   Year 5   March 1, 2014                                        100%                                         Check one:                        Actual A/V                    Limit
   Year 6   March 1, 2013                                        100%                                         Check one:                        Actual A/V                    Limit
   Year 7   March 1, 2012                                        95%                                          Check one:                        Actual A/V                    Limit
   Year 8   March 1, 2011                                        80%                                          Check one:                        Actual A/V                    Limit
   Year 9   March 1, 2010                                        65%                                          Check one:                        Actual A/V                    Limit
 Year 10    March 1, 2009                                        50%                                          Check one:                        Actual A/V                    Limit
TOTAL DEDUCTION CLAIMED (carry amount to page 1)                           $

                                            SPECIAL INSTRUCTIONS AND QUALIFICATIONS
1.  This deduction is only available for property located within an area that has been designated as a Maritime Opportunity District by the Indiana Port Commission.
2.  A Maritime Opportunity District is a geographical territory designated by the Indiana Port Commission under IC 6-1.1-40-7 and IC 6-1.1-40-8.
3.  The Commission may find that a geographic territory is a Maritime Opportunity District if the Commission determines that: (a) the territory is located adjacent to a state 
   owned port on state owned land; (b) there will be redevelopment or rehabilitation of property within the territory; (c) the redevelopment or rehabilitation will require a 
   substantial investment relative to the size of the business making the investment; (d) the business making the investment will be manufacturing goods; (e) more than 50% of 
   the goods manufactured are to be shipped through a port operated by the State of Indiana and are destined for international markets; (f) the business is making a long term 
   commitment to the territory; and (g) there will be an increase in the revenue of the port.
4.  For purposes of this deduction, “new manufacturing equipment” means any tangible personal property that (a) is installed in a Maritime Opportunity District; (b) is used in the 
   direct production, manufacture, fabrication, assembly, extraction, mining, processing, refining, or finishing of other tangle personal property; and (c) was acquired by its 
   owner for use as described above, and was never before used by its owner for any purpose in Indiana.
5.  An owner of new manufacturing equipment whose statement of benefits is approved is entitled to a deduction from the assessed value of that equipment for a period of 
   ten (10) years. Except as provided, for the first five (5) years, the amount of the deduction for new manufacturing equipment that an owner is entitled to for a particular 
   year equals the assessed value of the new manufacturing equipment. For the sixth through the tenth year, the amount of the deduction equals the product of: (a) 
   the assessed value of the new manufacturing equipment; multiplied by (b) the percentage prescribed in the following table, except as provided in special instruction #6:
                                            YEAR OF DEDUCTION                                PERCENTAGE
                                                            6th                              100%
                                                            7th                              95%
                                                            8th                              80%
                                                            9th                              65%
                                                            10th                             50%
                                                 11th and thereafter                         0%
6.  A deduction under special instruction #5 above is not allowed in the first year the deduction is claimed for new manufacturing equipment to the extent that it would cause the 
   assessed value of all personal property of the owner in the taxing district in which the equipment is located to be less than the assessed value of all the personal property of 
   the owner in that taxing district in the immediately preceding year. If a deduction is not fully allowed under special instruction #5 in the first year the deduction is claimed, then 
   the percentages specified in special instruction #5 apply in the subsequent years to the amount of the deduction that was allowed in the first year. (IC 6-1.1-40-10) 

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