State Form 55972 "Limited Delegation of Authority for Entering and Editing Data in the Indiana Gateway Website - Property Tax Assessment Board of Appeals (Ptaboa)" - Indiana

Form State55972 is a Indiana Department of Local Government Finance form also known as the "Limited Delegation Of Authority For Entering And Editing Data In The Indiana Gateway Website - Property Tax Assessment Board Of Appeals (ptaboa)". The latest edition of the form was released in January 1, 2016 and is available for digital filing.

Download a PDF version of the Form State55972 down below or find it on Indiana Department of Local Government Finance Forms website.

ADVERTISEMENT

Download State Form 55972 "Limited Delegation of Authority for Entering and Editing Data in the Indiana Gateway Website - Property Tax Assessment Board of Appeals (Ptaboa)" - Indiana

1260 times
Rate
4.8(4.8 / 5) 63 votes
Reset Form
LIMITED DELEGATION OF AUTHORITY FOR ENTERING AND
EDITING DATA IN THE INDIANA GATEWAY WEBSITE –
PROPERTY TAX ASSESSMENT BOARD OF APPEALS (PTABOA)
 
State Form 55972 (1-16)
Prescribed by the Department of Local Government Finance
I. LIMITED DELEGATION OF AUTHORITY
Name of Delegating Official (person giving rights):
Name of Delegate (person receiving rights):
Email address of the Delegate (person receiving rights):
Name of Unit:
Access Type (select one):
Edit
Read-only
I, the undersigned Delegating Official, pursuant to the authority vested in me for the submission of
PTABOA–related information through the Gateway website on behalf of the Unit, hereby delegate to
the above-designated Delegate the following authority for the limited purposes set forth below:
1. Delegate may enter and/or edit data (as designated above) on my behalf into the Gateway website to
prepare PTABOA-related information that will be submitted by the Unit to the Department of Local
Government Finance (Department) for the applicable calendar year.
2. Delegate may access the Unit’s Gateway website by means of the login and password created and
distributed by the Department to the Delegate.
3. This limited delegation of authority shall continue in effect until revoked.
I acknowledge that this Delegation does not affect the Unit’s duties or responsibilities under the Indiana
Code, and that I remain responsible for the accuracy, completeness, timeliness, and submission of all
PTABOA-related information. I hereby represent that I have the real and apparent authority to sign this
Delegation.
IN WITNESS WHEREOF, I have hereunto set my hand this
day of
, 20
(Signature of Delegating Official)
(Typed name and title of Delegating Official)
II. ACKNOWLEDGMENT BY DELEGATE
I, the Delegate in the above and foregoing, hereby acknowledge and accept the terms of the limited
delegation of authority.
(Signature of Delegate Official)
(Typed name and title of Delegate)
NOTICE OF LIMITATION OF LIABILITY BY DEPARTMENT
Upon receipt of a fully executed State Form 55972 from a local government unit, the Department will provide the unit’s delegate
with a login and password for access to the unit’s Gateway site. The Department is not a party to such a Delegation and has no other
responsibility or liability in connection therewith. The Department does not assume any liability or responsibility for the work
product or actions of the delegate, or for the accuracy, completeness, timeliness or usefulness of any material displayed or distributed
through the Gateway website database. The Department makes no warranty, express or implied, with respect to the information
 
included in the Gateway website database and has no responsibility or liability therefore.
Reset Form
LIMITED DELEGATION OF AUTHORITY FOR ENTERING AND
EDITING DATA IN THE INDIANA GATEWAY WEBSITE –
PROPERTY TAX ASSESSMENT BOARD OF APPEALS (PTABOA)
 
State Form 55972 (1-16)
Prescribed by the Department of Local Government Finance
I. LIMITED DELEGATION OF AUTHORITY
Name of Delegating Official (person giving rights):
Name of Delegate (person receiving rights):
Email address of the Delegate (person receiving rights):
Name of Unit:
Access Type (select one):
Edit
Read-only
I, the undersigned Delegating Official, pursuant to the authority vested in me for the submission of
PTABOA–related information through the Gateway website on behalf of the Unit, hereby delegate to
the above-designated Delegate the following authority for the limited purposes set forth below:
1. Delegate may enter and/or edit data (as designated above) on my behalf into the Gateway website to
prepare PTABOA-related information that will be submitted by the Unit to the Department of Local
Government Finance (Department) for the applicable calendar year.
2. Delegate may access the Unit’s Gateway website by means of the login and password created and
distributed by the Department to the Delegate.
3. This limited delegation of authority shall continue in effect until revoked.
I acknowledge that this Delegation does not affect the Unit’s duties or responsibilities under the Indiana
Code, and that I remain responsible for the accuracy, completeness, timeliness, and submission of all
PTABOA-related information. I hereby represent that I have the real and apparent authority to sign this
Delegation.
IN WITNESS WHEREOF, I have hereunto set my hand this
day of
, 20
(Signature of Delegating Official)
(Typed name and title of Delegating Official)
II. ACKNOWLEDGMENT BY DELEGATE
I, the Delegate in the above and foregoing, hereby acknowledge and accept the terms of the limited
delegation of authority.
(Signature of Delegate Official)
(Typed name and title of Delegate)
NOTICE OF LIMITATION OF LIABILITY BY DEPARTMENT
Upon receipt of a fully executed State Form 55972 from a local government unit, the Department will provide the unit’s delegate
with a login and password for access to the unit’s Gateway site. The Department is not a party to such a Delegation and has no other
responsibility or liability in connection therewith. The Department does not assume any liability or responsibility for the work
product or actions of the delegate, or for the accuracy, completeness, timeliness or usefulness of any material displayed or distributed
through the Gateway website database. The Department makes no warranty, express or implied, with respect to the information
 
included in the Gateway website database and has no responsibility or liability therefore.
ADVERTISEMENT
Fill PDF online