Free 53626.FH11 - Indiana

JOINT REPORT BY TAXPAYER / ASSESSOR TO THE COUNTY BOARD OF APPEALS OF A PRELIMINARY INFORMAL MEETING
State Form 53626 (5-08) Prescribed by the Department of Local Government Finance

FORM 134

FOR OFFICE USE ONLY
Date received by County Board of Appeals (month, day, year)

Reset Form

Date received by County Auditor (month, day, year)

INSTRUCTIONS: 1. This form must be completed and signed by both the taxpayer and the assessing official. The assessing official must forward this form to the County Auditor and the Property Tax Assessment Board of Appeals no later than ten (10) days after the preliminary informal meeting between the taxpayer and the undersigned assessing official. 2. The County Board of Appeals maintains the original report with copies provided to the County Auditor, Assessor, and taxpayer. TYPE OF ISSUE UNDER APPEAL
Assessment of (check if applicable): Deduction for (check if applicable):

Real property Personal property

Rehabilitated property (IC 6-1.1-12-25.5) Resource Recovery System (IC 6-1.1-12-28.5) Coal, hydroelectric, or geothermal (IC 6-1.1-12-35.5)

ERA - Real property (IC 6-1.1-12.1-5) ERA - Vacant building (IC 6-1.1-12.1-5.3) ERA - Personal property (IC 6-1.1-12.1-5.4)

SECTION 1
Assessment date: March 1, 20______, payable in 20______. Name of property owner

PROPERTY & PETITIONER INFORMATION
Parcel number County T elephone number Township

(

)

Mailing address of property owner (number and street, city, state and ZIP code) Address of property under appeal, if different (number and street, city, state and ZIP code) Name of authorized representative (if different from taxpayer) Mailing address of authorized representative (number and street, city, state and ZIP code) T elephone number

(

)
DLGF Taxing District number

SECTION 2 Current assessment / deduction of record

RESULTS OF PRELIMINARY INFORMAL MEETING LAND IMPROVEMENTS PERSONAL PROPERTY / DEDUCTIONS

Assessment date: March 1, 20______, payable in 20______.

Taxpayer believes assessment / deduction should be: Assessor believes assessment / deduction should be:
After the preliminary informal meeting, do the taxpayer and the assessor agree on the resolution of all issues?

Yes
If yes, explain the issues and changes made.

No

If both parties do not agree on all the issues, is there a partial agreement on some of the issues?

Yes
If yes, list the areas agreed upon.

No

If yes, list the areas not agreed upon.

If both parties disagree on all of the issues, the taxpayer and the assessor should list the issues in their comments section.

Page 1 of 2

TAXPAYER COMMENTS
Explain reasons for disagreement or changes made.

Signature of taxpayer

Date (month, day, year)

ASSESSOR COMMENTS
Explain reasons for disagreement or changes made.

Signature of assessor

Date (month, day, year)

Page 2 of 2