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eR +� TAXPAYER'S NOTICE TO INITIATE AN APPEAL FORM 130 -SHORT Sl� State Form 53958 (R2 / 7 -12) Assessment year under appeal Prescribed by the Department of Local Government Finance MARCH 1, 20 13 Hsu • The purpose of this form is to aid taxpayers in the filing of an appeal on an assessment. • This form is not required to be used to file an appeal. IC 6- 1.1 -15 -1 states that a taxpayer must file notice in writing with the Township or County Assessor. A handwritten letter would be acceptable as long as it contained the name of the taxpayer, the address and parcel number or key number of the property, and the address and telephone number of the taxpayer. • The appeal of an assessment requires evidence relevant to the true tax value of the taxpayer's property as of the assessment date. This evidence is not required to be provided at the time of filing the appeal; however, it could expedite the process if provided when available. Examples of evidence could include an appraisal, construction costs, sales information for the subject property or comparable properties, or any other information compiled according to generally accepted appraisal principles. NOTE: Indiana law does not require a taxpayer to submit an appraisal in order to appeal an assessment. r.hPnk tvne of nronertv under appeal (check only one): ❑✓ Real F Personal REQUIRED INFORMATION: SECTION I: PROPERTY & PETITIONER INFORMATION County Township Parcel or key number (for real property only) St. Joseph Portage 018 - 1002 -0040 Address of property being appealed (number and street, city state, and ZIP code) 237 N. Michigan St., South Bend IN 46601 Legal description on Form 11 or Property Record card (for real property), or business name (for personal property) Lot 1 of original Plat of South Bend Name of property owner Telephone number of property owner City of South Bend Department of Redevelopment ( 574 ) 235 -5836 Mailing address of property owner (number and street, city state, and ZIP code) Ste. 1400, 227 W. Jefferson Blvd., South Bend IN 46601 OPTIONAL INFORMATION NOT REQUIRED AT THE TIME OF FILING: SECTION II: REASON FOR APPEAL Land Improvements Personal Property The property described in Section I is currently assessed at: 33,400.00 773,700.00 0.00 The petitioner contends that the property should be assessed at: 108,355.00 115,434.00 0.00 List attached evidence or give reasons for requested change: Property has been for sale since 2005 (eight years)_ Only offers have been for a nominal amount because of the considerable investment necessary to make the building habitable. - City of South Bend's Department of Community Investment is negotiating the sale of this property for $1, with the developer pledging an investment of approximately-$9,000,000 - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ The attached appraisals, summary, and analysis support the above requested change in assessed value._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Name of authorized representative (if different from owner) Telephone number of authorized representative Mailing address of authorized representative (number and street. city, state, and ZIP code) Signature of petitioner, taxpayer, or duly authorized officer Date of signature (month,day, year) Printed or typed name of petitioner, taxpayer, or duly authorized officer Page 1 of 2