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DTE FORM 3
(Revised 10/13)
R.C. 5717.01
TRANSCRIPT ON APPEAL FROM COUNTY BOARD OF REVISION
BOR Case No._______________________
Appellant, (Please Print)
BTA Case No._______________________
v.
AUDITOR/FISCAL OFFICER AND THE BOARD OF REVISION
Tax Year at Issue _____________________
Date BOR Decision Mailed_____________
Of____________________________________ County, Ohio, and
_____________________________________________________
Date BOR Received
Notice of Appeal
_______________
Appellee(s) (All other parties to the appeal)
□ Never Received
Date BOR Notified All Other Parties of
Notice of Appeal filing ______________
A counter-complaint (copy attached) was filed by ___________________________________________________
□
Property Owner’s Name ________________________________________________________________________
Property Owner’s Address
_
st
nd
rd
1
Parcel
2
Parcel
3
Parcel
Parcel (or registration) No.
Parcel’s Address – Street
City, State & Zip
Parcel’s School District
Auditor’s/Fiscal Officer’s
Market Value
BOR’s Market Value
Small Claims Eligible: Qualifies for partial tax exemption set forth in R.C. 319.302. Yes
No
I certify that the foregoing statements are true and that the attached transcript is a true and complete record of the
proceedings before the board of revision pertaining to the decision appealed from and all evidence offered and
considered by the board of revision.
__________________________________________
_______________________________
(Signature)
Date
Auditor/Fiscal Officer of ____________________________ County
(BACK OF FORM MUST ALSO BE COMPLETED)