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Physical Characteristics of Property Being Appealed

(please verify all: “n/a” if not applicable):

Year Built:

Total number of fireplaces (incl bsmt):

Year house remodeled & cost:

Central air conditioning (yes or no):

Year kitchen remodeled & cost:

Number of bedrooms in basement:

Year bath/baths remodeled & cost:

Number of dens in basement:

Total number of rooms – condos only (incl bsmt):

Size of basement rec room (square feet):

Total number of bedrooms:

Second kitchen (yes or no):

Total number of full bathrooms w/tub or shower (incl bsmt):

Elevator (yes or no):

Total number of half bathrooms (incl bsmt):

Utilities (circle): Water

Sewer

Gas

Septic

Well

Sale Information on Property Being Appealed:

Most recent sale date and price:

Has the property under appeal been listed for sale in the last 3 years (yes or no - provide dates and prices):

Has the property under appeal been professionally appraised in the last 3 years (list appraised value and date;

submitting a copy of the appraisal may help expedite the review):

Comparable Properties

(attach additional pages to submit more than three comparables):

Provide information below relating to properties with characteristics, assessments or sales prices that support

your assessment appeal. Sales in 2010 can be considered for the 1/1/11 assessment; sales that occur in 2011 are

not applicable until the Jan. 1, 2012 assessment. Assistance information is noted at the bottom of this page.

Comparable #1:

Map Reference #:

Property Address:

Assessed Value: Land:

Improvement:

Total:

Sale Date:

Sale Price:

Style:

Model Name:

Comments:

Comparable #2:

Map Reference #:

Property Address:

Assessed Value: Land:

Improvement:

Total:

Sale Date:

Sale Price:

Style:

Model Name:

Comments:

Comparable #3:

Map Reference #:

Property Address:

Assessed Value: Land:

Improvement:

Total:

Sale Date:

Sale Price:

Style:

Model Name:

Comments:

Attach additional remarks or comments to this form as necessary.

Appeals may result in values being affirmed or adjusted upward or downward to establish a fair and

equitable assessment of the property. You will be provided with written notification of the results of the review.

How to receive assistance and research comparable properties:

1) Go online to

(click on “Real Estate Tax” and “View My Property”).

2) Call the Automated Information System 703-222-6740, TTY 711, Monday–Saturday from 7 a.m. to 7 p.m.

3) Call DTA staff at 703-222-8234, TTY 711 Monday through Friday between 8 a.m. and 4:30 p.m.

4) Visit the Department of Tax Administration, Real Estate Division at 12000 Government Center Parkway,

Suite 357, Fairfax, VA 22035, between 8 a.m. and 4:30 p.m. Monday through Friday.

To request this form in an alternate format, contact the Fairfax County Department of Tax Administration at 703-222-8234.

2011 Real Estate Assessment Appeal Application - Virginia Department Of Tax Administration Page 2

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