Form Pt 38 - Application For Freeze On Assessments Of Dwellings Of Disabled And Senior Citizens (Sdcl 10-6a) Page 2

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4.
Verification
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TO BE COMPLETED BY COUNTY TREASURER
I hereby certify this applicant meets all requirements for an assessment freeze as provided in SDCL 10-6A. The base year for
assessment freeze is ____.
_______________________________________________
________________________
Treasurer's Signature
date
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TO BE COMPLETED BY DIRECTOR OF EQUALIZATION
A. Parcel number of property for which assessment freeze is to apply: ________________________________________
B. Is the above described property a single family dwelling, condominium, apartment or manufactured home? _____
C. Is the current full and true value less than $150,000? ____________
D. Base year _______ assessment to be frozen $________________
PT 38 (06-04)
Original to Director of Equalization
First copy to County Treasurer
Second copy to Applicant
PRINT FOR MAILING
EXIT
CLEAR FORM
1.
2.

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