Form Pe-615a - Statement Of Assessment Page 2
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Column A
Column B
Column C
Assessed Value of General
Line
Metro Sewer
METROPOLITAN SEWERAGE DISTRICT NAMES
Property (Include Real Estate
No.
Dist. No.
& Personal Property)
3 3
34
Assessed Value of General
Sanitary
Property (Include Real Estate
SANITARY DISTRICT NAMES
Dist. No.
& Personal Property)
3 5
36
37
38
Assessed Value of General
PUBLIC INLAND LAKE PROTECTION AND
I
nland Lake
Property (Include Real Estate
REHABILITATION DISTRICT NAMES
Dist. No.
& Personal Property)
3 9
40
41
42
Assessed Value of General
Utility
Property (Include Real Estate
UTILITY DISTRICT NAMES
Dist. No.
& Personal Property)
43
44
45
46
Other
Assessed Value of General
OTHER SPECIAL PURPOSE DISTRICT NAMES
Special
Property (Include Real Estate
Dist. No.
& Personal Property)
47
48
Complete Certification information
CERTIFICATION (Local Clerk)
below, print and remember to sign.
I certify the foregoing statement to be correct, as appears in the assessment rolls referred to and which are now in this office.
(Signature of Clerk or Preparer)
(Title)
(Date)
Remember your signature.
All DATE entries should have - or /
Board of Review
Date of Final Adjournment
(must be filled in)
entered between m/d/yr
(
)
Telephone Numbers
E-mail Address
(Work/Home)
INSTRUCTIONS
The municipal clerk should complete this report as it is usually done for the entire municipality, however, it should only
include property within the TID or ER TID (DO NOT INCLUDE VALUES OF MUNICIPAL-OWNED TAX EXEMPT PROP-
ERTY). Be certain that all items below line 15 (first page) are completed and reflect the local assessed value of all general
property (subject to the general property tax) located within the particular tax incremental district. DO NOT attempt to
include Class 3 (Manufacturing) Real and Personal Property values on the Statement of Assessment form. If no special
districts apply to the TID or ER TID, write – NONE – in the appropriate area. Be sure to complete the certification portion
of this form, remembering to sign and date it.
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