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                 PETITION FOR REVIEW OF EXEMPTION 
                 BEFORE THE INDIANA BOARD OF TAX REVIEW                                                                                   FORM 132
                 State Form 21514 (R7 / 6-16) / IBTR Form 132                                                                            IBTR PETITION NUMBER
                 Prescribed by the Indiana Board of Tax Review

INSTRUCTIONS:       1.  Complete all sections of this petition.                                           __  __   --   __  __  __   --   __  __  --  2  --  8  --   __  __  __  __  __   --   __  __
                    2.  File this petition with the:                                                              Co.              Dist.  Appeal                         Sequence              Year 
                                Indiana Board of Tax Review                                                                                 Year                                               Filed
                                100 North Senate Avenue, Room N-1026
                                Indianapolis, IN 46204
                    3.  Mail a copy of this petition to the other party.  

FILING INFORMATION
Information regarding appeal procedures is available on the Indiana Board of Tax Review (IBTR) website located at www.in.gov/ibtr.
FILING DEADLINE:  This petition must be filed not later than forty-five (45) days after the Notice of Action on Exemption Application is given to the
taxpayer.  If the county board has failed to act on an exemption application and it has been more than one hundred eighty (180) days since the filing date
of the application, the owner may initiate an appeal to the IBTR.
ATTACHMENTS TO THIS PETITION:  The following information must be attached to this petition.
  1.  A copy of the underlying Application for Property Tax Exemption (State Form 9284 / Form 136).
  2.  A copy of the Notice of Action on Exemption Application (State Form 49585 / Form 120), or an explanation if the county board has not issued a notice
       of action.
  3.  The petition must be signed by the owner or an attorney at law.  
  4.  A listing of other related parcels that are currently on appeal.
Multiple years or multiple parcels require separate petitions, except that a party may ask the IBTR for permission to file a single petition for
multiple parcels where the parcels are contiguous and the issues to be appealed on each parcel are substantially similar.
FAILURE TO FOLLOW INSTRUCTIONS:  The Petitioner must complete all sections of this petition.  If the Petitioner does not comply with the instructions 
for completing this form, the IBTR may return the petition to the Petitioner with a description of the defect.  The Petitioner will then have thirty (30) days from
the date of the notice of defect to cure the defect and file a corrected petition.  If the corrected petition does not comply with the instructions for completing the
form, the IBTR may deny the petition. 
If the owner does not comply with the statutory procedures for obtaining an exemption, the owner waives the exemption.  If the exemption is waived, the
property is subject to taxation.
Check the type of property under appeal:                          Real        Personal                    Both
Is this property currently under appeal with the Indiana Board of Tax Review for another tax year?                                            Yes                 No
If yes, indicate year(s) and type of appeal(s): _____________________________________________________________________
Is this appeal being filed because the county board failed to act on the exemption application within one hundred eighty (180) days after the
owner filed the application for exemption?                         Yes         No

                                         SECTION  1:  PROPERTY AND PETITIONER INFORMATION
County                          Township                                  Parcel or Key number (for real property)

Address of property (number and street or rural route)                                                    City                                               ZIP Code

Legal description provided on Form 11 or Property Record Card (for real property) , or business name (for personal property)                     Assessment year under appeal
                                                                                                                                                         __________________
Name of property owner                                                              Telephone Number                    E-mail Address
                                                                                     (           )
Address of property owner (number and street or rural route)                        City                                                 State               ZIP Code

Name of licensed attorney                                                           Telephone Number                    E-mail Address
                                                                                     (           )
Address of licensed attorney (number and street or rural route)                     City                                                 State               ZIP Code

                             SECTION  2:  ACTION BY COUNTY PROPERTY TAX ASSESSMENT BOARD OF APPEALS
       List below the assessment determination issued by the County Property Tax Assessment Board of Appeals (from State Form 49585 / Form 120)
Assessment Date ________________                                % Exempt                                       % Taxable                                                 Total
                    Land
                 Improvements
       Personal Property

                                                                          Form 132, page 1Form 132, page 1



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                                                                                           SECTION  3:  GROUNDS FOR APPEAL
   Check the specific statute exemption is claimed under:
  Charitable IC 6-1.1-10-16                                                    Literary IC 6-1.1-10-16                                                           Scientific IC 6-1.1-10-16
  Educational IC 6-1.1-10-16                                                   Religious IC 6-1.1-10-16                                                          Fraternal Beneficiary Association IC 6-1.1-10-23
  Other (Cite to the specific statute under which exemption is claimed.) __________________________________
  For All Appeals:  Please explain in detail the basis for your belief that the subject property qualifies for exemption. 

                                                                SECTION  4:  OPTIONAL ELECTION OF ELECTRONIC SERVICE
  I elect to receive all notices regarding this petition by electronic mail.  I understand that the electronic mail notices are considered effective in the same
  mannermannerasasififthethenoticesnoticeshadhadbeenbeensentsentbbyUnitedUnitedStatesStatesmailmailtotothethepartparty's's mailingmailingaddressaddressofofrecordrecordandandaahardhardcopcopy willillnotnotbebeprovidedpro ided.
   Elect electronic service                                                    Initial               E-mail address for service

                                                                                                     SECTION  5:  SIGNATURES
  PROPERTY OWNER
  I certify that all entries on this form are accurate to the best of my knowledge and belief.  
Signature of property owner                                                                                                                                                    Date signed (month, day, year)

Printed or typed name of property owner                                                                                                                                        Title (Please print or type.)

  ATTORNEY REPRESENTATIVE
  I certify that all entries on this form are accurate to the best of my knowledge and belief.
Signature of attorney representative                                                                                                                                           Date signed (month, day, year)

Printed or typed name of attorney representative                                                                                                                               Attorney number

                                                                                     SECTION 6:  CERTIFICATE OF SERVICE
In addition to filing this petition with the IBTR, a copy of this petition must be mailed to the Respondent.  In most cases, the Respondent is the county assessor.
If this petition is filed by the county assessor, then the taxpayer is the Respondent.  Complete the date of service, the name and address of the party being
served, the manner of service, and then sign and date.

  I affirm under the penalties of perjury that on this  __________ day of __________________, 20_____, a copy of this petition has been served on:
                  Name:                                                                                                                                                        Manner of service:
              Address:                                                                                                                                                                  US Mail
                                                                                                                                                                                        Hand delivery
                                                                                                                                                                                        Other
 
                            Signature                                                                                                                                          Date (month, day, year)

                                                                                                             Form 132, page 2Form 132, page 2






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