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              JOINT REPORT BY TAXPAYER / ASSESSOR                                                                                  FOR OFFICE USE ONLY 
              TO THE COUNTY BOARD OF APPEALS OF                                                                 FORM  134        Date Received by PTABOA (month, day, year) 
              A PRELIMINARY INFORMAL MEETING 
              State Form53626 (R3 / 1-23) 
              Prescribed by the Department of Local Government Finance                                                           Date Received by Auditor (month, day, year) 

INSTRUCTIONS: 
1. This form must be completed and signed by both the taxpayer and the assessing official upon the completion of the required preliminary informal 
  meeting outlined in IC 6-1.1-15-1.2.
2.The PTABOA maintains the original report with copies provided to the county auditor, assessor, and taxpayer.

                                                                 TYPE OF ISSUE UNDER APPEAL 
Assessment of (check if applicable) :        Issue Concerning (check issue(s))) :
                                             ☐     Deduction     ☐   Credit                ☐        Exemption      ☐  Abatement  ☐  Tax Cap
☐  Real Property
                                             ☐     Other:  ________________________________________________________________________________
                                             Petition Number (assigned by local officials) 
☐  Personal Property

SECTION 1                                               PROPERTY AND PETITIONER INFORMATION 
                                                        Parcel Number                                           County             Township 
Assessment Date: January 1, _______, payable in _______ 
Name of Property Owner                                                                                          Telephone Number   Email Address
                                                                                                                (    ) 
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)                                                Telephone Number   Email Address
                                                                                                                (    ) 
Mailing Address of Authorized Representative (number and street, city, state, and ZIP code)                                      DLGF Taxing District Number 

SECTION 2                                               RESULTS OF PRELIMINARY INFORMAL MEETING 
Assessment Date: January 1, _______, payable in _______              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 
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?                    ☐ Yes     ☐ No 
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.

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                                                  TAXPAYER COMMENTS 
Explain Reasons for Disagreement or Changes Made: 

I am aware of my right to a review of these issues by the PTABOA and my right to appeal to the Indiana Board of Tax Review and then to the Indiana Tax Court. 
The appeals process is outlined in IC 6-1.1-15. 
Signature of Taxpayer                                               Date (month, day, year) 

                                                  ASSESSOR COMMENTS 
Explain Reasons for Disagreement or Changes Made: 

I affirm that the foregoing report represents the results of the informal meeting, including a meeting not held or otherwise unsuccessful, to be given to the PTABOA 
pursuant to IC 6-1.1-15-1.2(b). 
Signature of Assessor                                               Date (month, day, year) 

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