JOINT REPORT BY TAXPAYER / ASSESSOR TO THE COUNTY BOARD OF APPEALS OF A PRELIMINARY INFORMAL MEETING FOR OFFICE USE ONLY FORM 134 Date received by County Board of Appeals (month, day, year) State Form 53626 (5-08) Prescribed by the Department of Local Government Finance 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): Real property Personal property Deduction for (check if applicable): 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) 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) SECTION 1 PROPERTY & PETITIONER INFORMATION Assessment date: March 1, 20______, payable in 20______. Parcel number County Township T elephone number Name of property owner ( ) 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) T elephone number Name of authorized representative (if different from taxpayer) ( ) Mailing address of authorized representative (number and street, city, state and ZIP code) SECTION 2 DLGF Taxing District number RESULTS OF PRELIMINARY INFORMAL MEETING Assessment date: March 1, 20______, payable in 20______. LAND IMPROVEMENTS PERSONAL PROPERTY / DEDUCTIONS Current assessment / deduction of record 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 No Yes No If yes, explain the issues and changes made. If both parties do not agree on all the issues, is there a partial agreement on some of the issues? If yes, list the areas agreed upon. 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 American LegalNet, Inc. www.FormsWorkFlow.com 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 American LegalNet, Inc. www.FormsWorkFlow.com