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PETITION FOR REVIEW OF ORDER MAKING ANNUAL ADJUSTMENTS TO ASSESSED VALUATION
State Form 53949 (5-09) Prescribed by the Department of Local Government Finance pursuant to IC 6-1.1-14-7

YEAR
File Mark

NO.

INSTRUCTIONS: 1. To be filed with the county auditor of the county for which the annual adjustment order was made. FILING DEADLINE: Ten (10) days after public notice of the annual adjustment order is given. 2. See reverse side for additional instructions. PETITIONER INFORMATION
Name of petitioner Address (number and street or P.O. box, city, state, and ZIP code) Telephone number

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County for which petition is filed

PETITIONER OBJECTION TO ORDER (attach additional sheets if necessary)

PETITIONER SIGNATURE Petitioner hereby seeks review of the Department of Local Government Finances (Department) Order making annual adjustments to assessed valuations for 20____ pay 20____ property taxes. Petitioner, under the penalties of perjury of the State of Indiana, by signature affirms that he/she is an owner of property affected by the Department of Local Government Finance order.
Signature of petitioner Date signed (month, day, year)

RECEIPT FOR PETITION FOR REVIEW OF ANNUAL ADJUSTMENT ORDER
Name of petitioner Signature of county auditor Date filed (month, day, year) Date signed (month, day, year)

INSTRUCTIONS

1.

Petition for Review must be filed with the county auditor of the county to which the annual adjustment order was directed. Petition for Review must be filed within ten (10) days after notice of the order is given. The county assessor or township assessor, if any, may file a Petition for Review. If the county assessor or township assessor, if any, does not file a Petition for Review, at least ten (10) taxpayers must file a Petition for Review. Taxpayers who are not property owners in the county to which the order was directed but have property in a crosscounty unit, part of which unit intersects with the county to which the order is directed, are eligible to file a Petition for Review. If the county assessor, township assessor, if any, or at least ten (10) taxpayers file a Petition for Review, then the Department of Local Government Finance will set a hearing to be held on the Petition for Review in the county to which the annual adjustment order was directed.

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