NOTICE OF DESTRUCTION OR REMOVAL OF BUILDINGS NOTE: This notice must be filed with the Township Assessor or County Assessor within 30 days after the destruction or removal of the building. TO: Assessor You are hereby advised that the following: House ! Garage ! Barn ! Shed ! Trailer ! was removed or destroyed on , 20________ Located on Real Estate Parcel Number: ________________________________ Address: ________________________________________________________ City: _______________________ ZIP ______________ Reason: Burned ! Moved ! Other ! If "other, checked, Explain: __________________________________________________________________ I hereby request a proportionate reduction in assessed valuation for the period after the late of destruction and prior to the date upon which such building was substantially reconstructed or rebuilt. ___________________________ Owner Above declaration verified and affirmed: ___________________________ Assessor American LegalNet, Inc. www.USCourtForms.com