Form 21366 - Notice Of Assessment Of Land And Structures
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1NOTICE OF ASSESSMENT OF LAND AND STRUCTURES - FORM 11 R/A
State Form 21366 (R4 / 8-00)
Prescribed by State Board of Tax Commissioners
This notice indicates the assessed value of your property and how the Township Assessor has determined that value. If you disagree with any of the
information listed, contact your Township Assessor for clarification. You have the right to appeal this assessment by filing a Petition For Review Of
Assessment (Form 130) with the County Assessor within forty-five (45) days of the date this notice was mailed. You may obtain a copy of Form 130 at
the County Assessor's office.
Name and address of property owner
Legal description
Parcel or ID number
Property address
DWELLING GRADE FACTOR
DESCRIPTION OF RESIDENTIAL DWELLING
(* square feet is based on exterior size)
________ OR _______%
Occupancy
Story height
(Average construction equals 100%)
DWELLING CONSTRUCTION YEAR
EXTERIOR WALL
FLOOR
SQUARE
FINISHED LIVING
_________________
CONSTRUCTION
FOOT AREA
LEVEL
AREA FOOTAGE
If the structure has been remodeled, the effective
year of the construction may be different than the
1st floor
actual year of construction.
DWELLING CONDITION RATING: _________
DWELLING NEIGHBORHOOD RATING: ______
Attic/Loft
DESCRIPTION OF YARD STRUCTURES
Basement
Crawl
I.D.
ITEM
GRADE
SIZE
COND.
01
NO
DWELLING ADJUSTMENTS
YES
SQUARE FOOTAGE
02
Unfinished interior
03
Extra living units
04
Basement recreation room
05
Central heating system
06
Air conditioning system
07
Fully electric
08
Fireplace opening(s)
09
Plumbing in dwelling:
10
Number of full baths (3 fixtures)
11
Number of half baths (2 fixtures)
12
Number of kitchen sinks
13
Number of water heaters
14
Number of extra fixtures
15
Garages:
16
17
Integral garage
Attached garage
PREVIOUS ASSESSMENT AT 100% OF TRUE TAX VALUE
LAND
Attached carport
Basement garage
STRUCTURES
TOTAL
Exterior features to dwelling:
1.
NEW ASSESSMENT EFFECTIVE MARCH 1, _______
2.
3.
LAND
4.
STRUCTURES
5.
TOTAL
Reason for revision of assessment:
County
Township
Date of Notice
Township Assessor
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