Form Ceu-3 - Uniform Request For Continuing Education Credit Form 2000 printable pdf download

Form Ceu-3 - Uniform Request For Continuing Education Credit Form 2000

DEPARTMENT OF TREASURY

DIVISION OF TAXATION, PROPERTY ADMINISTRATION

ASSESSOR CERTIFICATION RENEWAL PROGRAM

UNIFORM REQUEST FOR CONTINUING EDUCATION CREDIT

To be completed by attendee:

Name of Attendee: ______________________________________________________________

Certification Number: ___________________________________________________________

Mailing Address :_______________________________________________________________

City: ____________________________________ State: ________ Zip: ___________________

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To be completed by sponsoring agency

Course/Seminar Information

Title: ______________________________ Number of Hours Administration: ______________

Number of Hours Appraisal: __________________

Sponsor: ________________________________________________________________________

Date: ________________________ Location: ______________________ Course #: __________

Description of Course/Seminar:

________________________________________________________________________________

(You may attach information about the course/seminar that may help in description).

Evidence of Completion: __________________________________________________________

(signature of instructor/sponsor representative)

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I certify that I have completed the above course/seminar and request continuing education

credit. I am aware that any misrepresentation by me may result in disciplinary action by the

Tax Assessor Continuing Education Eligibility Board (CEE Board).

Signature of Certified Tax Assessor: __________________________________ Date: _________

Please retain this form for your records. This must be submitted to the Division of Taxation

for proof of course completion along with your record of continuing education/certification

renewal once you've completed 50 credit hours/30 credit hours of continuing education.

CEU-3 (July 2000)

Form Ceu-3 - Uniform Request For Continuing Education Credit Form 2000