Certificate Of Assessment To Be Returned To Municipal Treasurer Form
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1CERTIFICATE OF ASSESSMENT TO BE RETURNED TO MUNICIPAL TREASURER
STATE OF MAINE
County of___________________________________, ss.
We hereby certify, that we have assessed a tax on the estate, real and personal liable to be taxed in the
Municipality of __________________________________ for the fiscal year
__________________ to ______________________, at ________________ mils on the dollar, on a total
m/d/y
m/d/y
taxable valuation of $_____________________________.
Assessments:
1. County Tax
$____________________
2. Municipal Appropriation
$____________________
3. TIF Financing Plan Amount
$____________________
4. School/Educational Appropriation
$____________________
5. Overlay Not to Exceed 5% of “Net To Be
Raised” (see tax rate calculation #16)
$____________________
6. Total Assessments
$____________________
Deductions:
7. State Municipal Revenue Sharing
$____________________
8. Homestead Reimbursement
$____________________
9. BETE Reimbursement
$____________________
10. Other Revenue
$____________________
11. Total Deductions
$____________________
12. Net Assessment for Commitment
$____________________
(line 6 minus line 11)
Lists of all the same we have committed to___________________________, Tax Collector
of said Municipality, with warrants in due form of law for collecting and paying the same to
_______________________________, Municipal Treasurer of said Municipality, or the successor in office, on
or before such date, or dates, as provided by legal vote of the Municipality and warrants received pursuant to
the laws of the State of Maine. (Title 36 MRSA, section 712)
Given under our hands this ____________________________.
m/d/y
____________________________________________________ Municipal Assessor(s)
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Complete in Duplicate. File original with Treasurer. File copy in Valuation Book
PTA 201 (4/08)
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