Form Rp-3611 - Attainment Aid - Payment # 3 Page 2
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2RP-3611(4/96)
COUNTY APPLICATION:
The County of _________________ is applying on behalf of the assessing units listed below. Additional sheets
should be attached as needed.
SWIS CODE
CITY/TOWN NAME
DATE OF FINAL
NUMBER OF
ASSESSMENT ROLL*
PARCELS**
FOR OFFICE USE ONLY
TOTALS:
* The date of the final assessment roll that was filed in the year immediately preceding or the year immediately following the completion of the data
collection program.
** The total number of separately assessed parcels appearing on the final assessment roll on behalf of which this application is made, excluding special
franchise parcels (roll section 5) which are assessed by the State.
I certify that this application is made on behalf of the municipalities listed above with their
knowledge and authorization.***
Signed:
Date:
(County Director)
*** Must be signed for a county application.
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