Form 801 - Assessor Notification - 2008 Page 2

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801
ASSESSOR NOTIFICATION
Form
(page 2)
A.
B.
C.
D.
E.
F.
Property
State of Origin
Number
Date Placed in
Original
Assessed Value
Description
(if acquired
of Years
Service
Cost
(To be completed by
used)
Claimed
(month/year)
local tax assessor.)
16. __________________________
_______
______
__________
/
$ _____________
$ _____________
17. __________________________
_______
______
__________
______________
______________
18. __________________________
_______
______
__________
______________
______________
19. __________________________
_______
______
__________
______________
______________
20. __________________________
_______
______
__________
______________
______________
21. __________________________
_______
______
__________
______________
______________
22. __________________________
_______
______
__________
______________
______________
23. __________________________
_______
______
__________
______________
______________
24. __________________________
_______
______
__________
______________
______________
25. __________________________
_______
______
__________
______________
______________
26. __________________________
_______
______
__________
______________
______________
27. __________________________
_______
______
__________
______________
______________
28. __________________________
_______
______
__________
______________
______________
29. __________________________
_______
______
__________
______________
______________
30. __________________________
_______
______
__________
______________
______________
31. __________________________
_______
______
__________
______________
______________
32. __________________________
_______
______
__________
______________
______________
33. __________________________
_______
______
__________
______________
______________
34. __________________________
_______
______
__________
______________
______________
35. __________________________
_______
______
__________
______________
______________
36. __________________________
_______
______
__________
______________
______________
37. __________________________
_______
______
__________
______________
______________
(
Attach additional sheets if needed)
_____________
TOTAL $ _ ______________
$
SECTION 3. Property Tax Information (To be completed by local tax assessor.)
Property Tax Rate ___________________ Assessed Tax $ _____________________ For Taxes Assessed April 1, ___________
Assessor Signature _______________________________ Municipality Name _______________________ Date ___________
______________________________________
____________________________________
_________________
Taxpayer (or agent) signature
Social Security number or federal EIN (see note, p.4)
Date
REV. 06/08

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