IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA CIVIL DIVISION _____________________________________ (name) Appellant, -vs_____________________________________ (name(s)) Appellee(s). ) ) ) ) ) ) ) ) No.: PETITION FOR APPEAL FROM DECISION OF THE BOARD OF ASSESSMENT APPEALS This Petition for Appeal from Decision of the Board of Assessment Appeals is filed pursuant to Local Rule 5000.1 by (name): 1. The owner of this commercial/residential (choose one) real estate or taxable property is _________________________________________, and the address of this real estate is _______________________________________________________(the "Property"). The Property has been assigned Parcel Identification Number ______________________________. 2. The County of Washington, the municipality and the school district __________________are the taxing bodies interested in the taxable status of the Property. 3. The Washington County Tax Assessment Office made an assessment of the Property. ______________________________________________ appealed from this assessment to the Board of Property Assessment Appeals (the "Board") asking that the assessment be reduced/raised (choose one). The Board is authorized to hear all appeals from assessments made by the Washington County Tax Assessment Office. 4. Following a hearing, a Decision of Appeal from Real Estate Assessment was mailed by the Board. 5. Petitioner is filing the appeal to the Common Pleas Court of Washington County. American LegalNet, Inc. www.FormsWorkFlow.com 6. Reasons for appeal: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ WHEREFORE, Petitioner requests this Honorable Court to set the assessment to such amount as may be right and\or proper. Date: _______________________ ____________________________________ (Signature) Note: Pennsylvania law permits the Court to increase or decrease the assessment, or to leave the decision of the Board intact, no matter who appealed. VERIFICATION ______________________________ (Name of Appellant) hereby verifies that the statements made in he attached Petition for Appeal From Decision of the Board of Assessment Appeals are true and correct, and understands that false statements made herein are subject to the penalties of 18 Pa. C.S. �4905 relating to unsworn falsification to authorities. Date: ___________________________ ____________________________________ (Signature) American LegalNet, Inc. www.FormsWorkFlow.com