Form 150-310-063 - Real Property Petition - 2005-2006
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1
2Board of Property Tax Appeals
For Offi cial Use Only
Petition Number and Date Received
2005–2006 REAL PROPERTY PETITION
Click Here to Clear Form
for
County
•
or
the requested information on both sides of this petition.
Please print
type
• Complete
form for
you are appealing.
one petition
each account
• Return your completed petition(s) to the address shown on the back.
•
Please attach a copy of your tax statement.
• Read all instructions carefully before completing this form.
Petitioner
(Person in whose name petition is fi led)
Owner
1 Check the box that applies:
Person or business, other than owner, obligated to pay taxes (attach proof of obligation)
2 Name—individual, corporation, or other business
3 Telephone number
(
)
(
)
Daytime
Evening
4 Mailing address (street or PO Box)
5 City
6 State
7 ZIP code
8 Name of person acting for corporation or other business
9 Title (i.e., president, vice president, tax manager, etc.)
}
FOR
BUSI NESS
USE ONLY
Member-man aged LLC
Manager-managed LLC
10 For Limited Liability Companies only:
If a representative is named on line 11, all correspondence regarding this petition will be mailed or delivered to the representative.
}
To be completed when petition is signed by an authorized representative of petitioner. Only certain
Representative
people qualify to act as an authorized representative. See the instructions for a list of who qualifi es.
11 Name of representative
12 Telephone number
(
)
(
)
Daytime
Evening
13 Mailing address (street or PO Box)
14 City
15 State
16 ZIP code
17 Relationship to petitioner named on line 2
18 Oregon state bar number
19 Oregon appraiser license number
20 Oregon broker license number
21 Oregon CPA or PA permit or S.E.A. number
Any refund resulting from this appeal will be made payable to the petitioner named on line 2 unless separate written authorization is made
to the county tax collector.
Attendance at Hearing
Check this box
wish to be present or be represented at the hearing. If you choose to not be present at the hearing, the board
if you do not
22
will make a decision based on the written evidence you submit.
Property Information
23 Assessor’s account number (from your tax statement)
24 Assessor’s map and tax lot number (from your tax state ment)
25 Street address and city where property is located
26 Property type
Residential
Commercial
Farm
Mfd Struc ture
Multi-family
Forest
Industrial
150-310-063 (Rev. 9-05)
Please turn over—form continues on back
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