BOARD OF ASSESSMENT APPEALS WESTMORELAND COUNTY 40 NORTH PENNSYLVANIA AVE, SUITE 440 GREENSBURG, PA 15601 (724) 830-3408 FAX: (724) 830-3852 ANNUAL TAX ASSESSMENT APPEAL APPLICATION ( A completed and signed Appeal Form must be returned to our office on or before First in order to be valid. Faxed or emailed copies are not accepted.) DATE: I (we) hereby appeal from the assessed valuation made upon my (our) property situated in (Twp. / Borough / City). The property is known as (please give proper street address) The property is located (please give directions from Court House) TAX MAP NUMBER : - - - - - - (Number is noted on your property tax bill or call 724-830-3409 Tax Assessment Office for assistance.) A separate completed and signed form is required for each Tax Map Number you are appealing. GO TO PAGE TWO **DO NOT WRITE BELOW THIS LINE** TED : RECEIVED : HEARING DATE : TIME: (a.m./p.m.) POSTPONED: WITHDRAWN: ABANDONED: HEARING HELD: AD MI NISTRATIVE REVIEW: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com PLEASE ANSWER ALL APPLICABLE QUESTIONS (Please Read Instructions BEFORE Completing) (Print or type) PROPERTY TYPE: Residential Commercial Industrial Vacant Land Farm Other (IF PROPERTY IS INCOME PRODUCING, PLEASE ATTACH AN INCOME & EXPENSE STATEMENT) BRIEF DESCRIPTION OF THE PROPERTY: DATE PURCHASED: How did you acquire this property? TOTAL PRICE PAID FOR PROPERTY $ COMMENTS: (Land, Buildings/Improvements) IF NEW CONSTRUCTION, DATE COMPLETED: COMMENTS: AMOUNT THE ENTIRE PROPERTY IS INSURED FOR $ WHY ARE YOU APPEALING THIS ASSESSMENT? IF YOU HAVE A CURRENT APPRAISAL OF THE PROPERTY, PLEASE INCLUDE A COPY. IF YOU ARE APPEALING THE VALUE OF A MOBILE HOME , PLEASE INCLUDE A COPY OF THE SALES RECEIPT AND TITLE , IF AVAILABLE. YOU MUST INCLUDE THE TAX MAP NUMBER OF ALL COMPARABLE PROPERTIES THAT YOU SUPPLY. IN YOUR OPINION, WHAT IS THE CURRENT FAIR MARKET VALUE OF THE PROPERTY YOU ARE APPEALING? $ ADDITIONAL COMMENTS OR EXTENUATING CIRCUMSTANCES: NAME: ADDRESS: TELEPHONE: HOME WORK ALTERNATE I have examined the information provided herewith and, to the best of my knowledge and belief, it is true, correct and complete. Aggrieved Party Signature (Signature) (Name Printed) Date Corporate Title (If Applicable) **** APPEAL NOT VALID UNLESS SIGNED **** Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com