BOARD OF ASSESSMENT APPEALS WESTMORELAND COUNTY 40 NORTH PENNSYLVANIA AVE, SUITE 440 GREENSBURG, PA 15601 (724) 830-3408 FAX: (724) 830-3852 APPEAL FROM CHANGE IN ASSESSED VALUATION ( A completed and signed Appeal Form must be returned to our office on or before 40 days from the mailing date on the Official Notice of Change in Assessed Valuation letter. Faxed or emailed copies are not accepted.) DATE: I (we) hereby appeal from the assessed valuation made upon my (our) property situated in The property is known as (please give proper street address) (Twp. / Borough / City). The property is located (please give directions from Court House) TAX MAP NUMBER: - - - - - - (Number is noted on your Official Notice of Change in Assessed Valuation letter, 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HEARING DATE: _________________________________________ TIME: __________________ (a.m./p.m.) POSTPONED: _______ WITHDRAWN: ______ ABANDONED: ________ HEARING HELD: ________ ADMINISTRATIVE REVIEW: ________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com [Please read enclosed instructions before completing] [Please print or type] PLEASE ANSWER ALL APPLICABLE QUESTIONS Residential Commercial Industrial Farm Other PROPERTY TYPE (CHECK ONE): Vacant Land (IF PROPERTY IS INCOME PRODUCING, PLEASE ATTACH AN INCOME & EXPENSE STATEMENT) BRIEF DESCRIPTION NEW CONSTRUCTION: DATE NEW CONSTRUCTION COMPLETED: COMMENTS: TOTAL COST OF NEW CONSTRUCTION: COMMENTS: (Attach documentation, if possible) IF YOU ARE APPEALING THE VALUE OF A MOBILE HOME: SIZE YEAR: TOTAL COST: X TIP-OUT OR ADDITION? SIZE X WAS THIS MOBILE HOME PREVIOUSLY ASSESSED ON ANOTHER PARCEL WITHIN WESTMORELAND COUNTY? YES NO TAX MAP NUMBER OF PREVIOUS ASSESSMENT: - WHY ARE YOU APPEALING THIS ASSESSMENT? (Attach additional sheets if necessary) 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 APPLICABLE. 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: TELEPHONE: HOME WORK ADDRESS 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 ________________________________ (Name Printed) Corporate Title (If Applicable) Date: *** APPEAL NOT VALID UNLESS SIGNED *** Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com