State Form 53854 Form 103-sr - Single Return - Business Tangible Personal Property - Indiana

Form State53854 is a Indiana Department of Local Government Finance form also known as the "Form 103-sr - Single Return - Business Tangible Personal Property". The latest edition of the form was released in October 1, 2018 and is available for digital filing.

Download a PDF version of the Form State53854 down below or find it on Indiana Department of Local Government Finance Forms website.

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January 1, 2019
SINGLE RETURN -
FORM 103-SR
BUSINESS TANGIBLE PERSONAL PROPERTY
For assessor's use only
PRIVACY NOTICE
State Form 53854 (R10 / 10-18)
This form contains
Prescribed by the Department of Local Government Finance
information confidential
pursuant to IC 6-1.1-35-9.
NOTE: For taxpayers with less than $20,000 in acquisition costs to report within the county, legislation was passed in 2015 which exempts this property. If
you are declaring this exemption, check this box, enter the total acquisition cost of your personal property in the county, and complete only sections I and IV
of this form. If you are declaring this exemption through this form, you do not need to file a Form 104-SR.
$ ________________________
RETURN THIS FORM TO THE APPLICABLE ASSESSOR BY MAY 15, 2019.
An exemption granted under IC 6-1.1-10 or any other statute supersedes this exemption. In other words, a taxpayer whose personal property is exempt
because the taxpayer applied for and was granted an exemption by the county must follow all applicable procedures for the approved exemption, which
may include fully completing the personal property return.
SECTION I
Name of taxpayer
Name to which assessment and tax notice are to be mailed
County
Address to which assessment and tax notice are to be mailed (number and street, city, state, and ZIP code)
Federal Identification Number **
Nature of business
NAICS code number *
SECTION II
1. Federal income tax year ends
2. Name under which federal return is filed
3. Location of accounting records
4. Form of business
Partnership or Joint Venture
Sole Proprietorship
Corporation
Estate or Trust
Other (describe) _________________________________________
5. Did you own, hold, possess, or control any leased, rented, or
If yes, file Form 103-N or Form 103-O (see 50 IAC 4.2-8-3 and 4).
other depreciable personal property on January 1?
Yes
No
Failure to properly disclose lease information may result in a double assessment.
SECTION III
LOCATION SUMMARY:
List each location where you own, hold, possess or control personal property subject to
Additional locations
assessment. Include the complete address (street address) for each location. Assign a
Page ________ of ________
location number to each separate location. Attach additional sheets if necessary.
LOCATION
DLGF TAXING
NAME UNDER WHICH BUSINESS IS CONDUCTED (if different than above)
TOWNSHIP
NUMBER
DISTRICT NUMBER
AND SPECIFIC STREET ADDRESS (number and street, city, state, and ZIP code)
SUMMARY
LOCATION NUMBER
LOCATION NUMBER
LOCATION NUMBER
____________
____________
____________
(Round all numbers to nearest ten dollars.)
SCHEDULE A - PERSONAL PROPERTY
+
$
$
$
FINAL ASSESSED VALUE
=
$
$
$
SUMMARY
LOCATION NUMBER
LOCATION NUMBER
LOCATION NUMBER
____________
____________
____________
(Round all numbers to nearest ten dollars.)
SCHEDULE A - PERSONAL PROPERTY
+
$
$
$
FINAL ASSESSED VALUE
=
$
$
$
* NAICS - North American Industry Classification System - A complete list of codes may be found at www.census.gov. For further information, contact the
Assessor (contact information is available at http://www.in.gov/dlgf/2440.htm).
** An individual using his/her Social Security Number as the Federal Identification Number is only required to provide the last four (4) digits of that number. IC 4-1-10-3
SECTION IV
SIGNATURE AND VERIFICATION
Under penalties of perjury, I hereby certify that this return (including accompanying schedules and statements), to the best of my knowledge and belief,
is true, correct and complete; reports all tangible personal property subject to taxation, owned, held, possessed or controlled by the named taxpayer in
the stated township or taxing district on the assessment date of this return, as required by law; and is prepared in accordance with IC 6-1.1 et seq., as
amended, and regulations promulgated with respect thereto.
Signature of authorized person
Date (month, day, year)
Printed name of authorized person
Title
T elephone number
(
)
Signature of person preparing return, if different than authorized person
Name and contact information of preparer
Page ______ of ______
Reset Form
January 1, 2019
SINGLE RETURN -
FORM 103-SR
BUSINESS TANGIBLE PERSONAL PROPERTY
For assessor's use only
PRIVACY NOTICE
State Form 53854 (R10 / 10-18)
This form contains
Prescribed by the Department of Local Government Finance
information confidential
pursuant to IC 6-1.1-35-9.
NOTE: For taxpayers with less than $20,000 in acquisition costs to report within the county, legislation was passed in 2015 which exempts this property. If
you are declaring this exemption, check this box, enter the total acquisition cost of your personal property in the county, and complete only sections I and IV
of this form. If you are declaring this exemption through this form, you do not need to file a Form 104-SR.
$ ________________________
RETURN THIS FORM TO THE APPLICABLE ASSESSOR BY MAY 15, 2019.
An exemption granted under IC 6-1.1-10 or any other statute supersedes this exemption. In other words, a taxpayer whose personal property is exempt
because the taxpayer applied for and was granted an exemption by the county must follow all applicable procedures for the approved exemption, which
may include fully completing the personal property return.
SECTION I
Name of taxpayer
Name to which assessment and tax notice are to be mailed
County
Address to which assessment and tax notice are to be mailed (number and street, city, state, and ZIP code)
Federal Identification Number **
Nature of business
NAICS code number *
SECTION II
1. Federal income tax year ends
2. Name under which federal return is filed
3. Location of accounting records
4. Form of business
Partnership or Joint Venture
Sole Proprietorship
Corporation
Estate or Trust
Other (describe) _________________________________________
5. Did you own, hold, possess, or control any leased, rented, or
If yes, file Form 103-N or Form 103-O (see 50 IAC 4.2-8-3 and 4).
other depreciable personal property on January 1?
Yes
No
Failure to properly disclose lease information may result in a double assessment.
SECTION III
LOCATION SUMMARY:
List each location where you own, hold, possess or control personal property subject to
Additional locations
assessment. Include the complete address (street address) for each location. Assign a
Page ________ of ________
location number to each separate location. Attach additional sheets if necessary.
LOCATION
DLGF TAXING
NAME UNDER WHICH BUSINESS IS CONDUCTED (if different than above)
TOWNSHIP
NUMBER
DISTRICT NUMBER
AND SPECIFIC STREET ADDRESS (number and street, city, state, and ZIP code)
SUMMARY
LOCATION NUMBER
LOCATION NUMBER
LOCATION NUMBER
____________
____________
____________
(Round all numbers to nearest ten dollars.)
SCHEDULE A - PERSONAL PROPERTY
+
$
$
$
FINAL ASSESSED VALUE
=
$
$
$
SUMMARY
LOCATION NUMBER
LOCATION NUMBER
LOCATION NUMBER
____________
____________
____________
(Round all numbers to nearest ten dollars.)
SCHEDULE A - PERSONAL PROPERTY
+
$
$
$
FINAL ASSESSED VALUE
=
$
$
$
* NAICS - North American Industry Classification System - A complete list of codes may be found at www.census.gov. For further information, contact the
Assessor (contact information is available at http://www.in.gov/dlgf/2440.htm).
** An individual using his/her Social Security Number as the Federal Identification Number is only required to provide the last four (4) digits of that number. IC 4-1-10-3
SECTION IV
SIGNATURE AND VERIFICATION
Under penalties of perjury, I hereby certify that this return (including accompanying schedules and statements), to the best of my knowledge and belief,
is true, correct and complete; reports all tangible personal property subject to taxation, owned, held, possessed or controlled by the named taxpayer in
the stated township or taxing district on the assessment date of this return, as required by law; and is prepared in accordance with IC 6-1.1 et seq., as
amended, and regulations promulgated with respect thereto.
Signature of authorized person
Date (month, day, year)
Printed name of authorized person
Title
T elephone number
(
)
Signature of person preparing return, if different than authorized person
Name and contact information of preparer
Page ______ of ______
SCHEDULE A FOR FORM 103-SR
JANUARY 1, 2019
Part of State Form 53854 (R10 / 10-18)
INSTRUCTIONS:
PLEASE TYPE or PRINT.
This form must be filed with the County Assessor of the county in which the property is located not later than May 15, 2019 unless an
extension is granted in writing. Contact information for the Assessor is available at http://www.in.gov/dlgf/2440.htm.
This form is for use by taxpayers who have personal property in more than one (1) township in a county.
If you are claiming any special adjustments such as equipment not placed in service, special tooling, permanently retired equipment,
abnormal obsolescence, economic revitalization, or other deductions, file the Form 103 Long.
Assign a location number to each separate location within a county.
If more than one page is necessary, attach additional forms and indicate you have done so on the front of the Form 103-SR.
A Form 104-SR must be filed with this return unless the exemption is claimed.
NOTE:
The location numbers shown below must correspond with the locations and location numbers shown on the front of this form (Form 103-SR) and on
the reverse side of Form 104-SR.
The County Assessor may refuse to accept a single personal property tax return that does not have attached to it a schedule listing, by township, all the
personal property of the taxpayer and the assessed value of the property for each taxing district as required. [IC 6-1.1-3-7(e)]
DEPRECIABLE PERSONAL PROPERTY
LOCATION NUMBER
#
#
#
#
#
#
TAXING DISTRICT NUMBER
COLUMN A
COLUMN B
COLUMN A
COLUMN B
COLUMN A
COLUMN B
LINE
YEAR OF ACQUISITION
TTV%
TOTAL COST
TTV
TOTAL COST
TTV
TOTAL COST
TTV
1-2-18 To 1-1-19
1
40%
1-2-17 To 1-1-18
2
60%
1-2-16 To 1-1-17
3
55%
3-2-15 To 1-1-16
4
45%
3-2-14 To 3-1-15
5
37%
3-2-13 To 3-1-14
6
30%
3-2-12 To 3-1-13
7
25%
3-2-11 To 3-1-12
8
20%
3-2-10 To 3-1-11
9
16%
3-2-09 To 3-1-10
10
12%
Prior To 3-2-09
11
10%
TOTALS
12
30% of line 12, Column A
13
Line 14 must be the greater of Line 12, Column B or Line 13 [see 50 IAC 4.2-4-9]
Total True Tax Value (TTV) of
14
Depreciable Personal Property
(to Summary on Form 103-SR)
DEPRECIABLE PERSONAL PROPERTY
LOCATION NUMBER
#
#
#
TAXING DISTRICT NUMBER
#
#
#
COLUMN A
COLUMN B
COLUMN A
COLUMN B
COLUMN A
COLUMN B
LINE
YEAR OF ACQUISITION
TTV%
TOTAL COST
TTV
TOTAL COST
TTV
TOTAL COST
TTV
1-2-18 To 1-1-19
1
40%
1-2-17 To 1-1-18
2
60%
1-2-16 To 1-1-17
3
55%
3-2-15 To 1-1-16
45%
4
3-2-14 To 3-1-15
5
37%
3-2-13 To 3-1-14
6
30%
3-2-12 To 3-1-13
7
25%
3-2-11 To 3-1-12
8
20%
3-2-10 To 3-1-11
16%
9
3-2-09 To 3-1-10
10
12%
Prior To 3-2-09
11
10%
TOTALS
12
30% of line 12, Column A
13
Line 14 must be the greater of Line 12, Column B or Line 13 [see 50 IAC 4.2-4-9]
Total True Tax Value (TTV) of
14
Depreciable Personal Property
(to Summary on Form 103-SR)
Page ______ of ______
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