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FOR BOE USE ONLY

IMPORTANT: READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

APPLICATION NUMBER

Application for Equalization of Real Property Assessment

Fairfax County Board of Equalization

MAP REFERENCE NUMBER

of Real Estate Assessments

PLAT

BLK OR

SUBDIV

PARCEL OR LOT

NUMBER

SEC

12000 Government Center Parkway, Suite 331

Fairfax, Virginia 22035-0033

Phone: 703-324-4891 Fax: 703-449-1888

TYPE OR PRINT INFORMATION CLEARLY AND SUBMIT IN DUPLICATE TO BOE OFFICE BY JUNE 1, 2004

Property Street Address:

Property Location (City):

Property Zip Code:

Building Name (if any):

Name of owner (s) on January 1, 2004:

Assessment: Land:

Improvement:

Total:

Basis for appeal (you must select at least one):

FAIR MARKET VALUE

This property is assessed greater or lesser than its Fair Market Value.

LACK OF UNIFORMITY: This property and one or more similar properties have different ratios of assessed value to 100% fair market value.

LACK OF EQUITABILITY

This property is physically identical to one or more other properties, but assessments are dissimilar.

ERRORS IN PROPERTY DESCRIPTION

Assessment is based upon inaccurate information concerning this property, such as lot size,

square footage, condition of property, flood plain, topography, zoning, etc.

APPLICANT INFORMATION

I believe the proper assessment of this property on January 1, 2004 should be:

Land:

Improvement:

Total:

Check One:

I am the owner of record

I am not the owner of record

If the applicant is not the owner of record of the subject property, the application must include a Letter of Authorization from the owner. Such

authorization must be signed by the owner prior to the date of application and either be written on the owner’s letterhead or notarized. For income producing

properties, a completed copy of the Fairfax County Department of Tax Administration annual income/expense survey, as submitted to Fairfax County for the

calendar years 2002 and 2003, along with applicable rent rolls, must be included with this application.

I hereby certify that the facts contained herein and attached hereto are true, accurate, and correct, to the best of my knowledge and belief.

Given under my hand this ______ day of _______________________, 2004

Signature of Applicant: _______________________________________________________________________________

Relation to property owner: (Attorney, Tax Rep., etc.): ______________________________________________________

Type or print name of applicant: ________________________________________________________________________

Phone: Work (

) ____________________ Home (

) ____________________

Mailing address

: ______________________________________________________________________________________________

Applicant’s failure to complete all sections of this application and/or the failure of the representative of an owner to include the owner’s authorization

may result in a denial of the application for hearing.

When this appeal is filed, the valuation of both land and improvement are reopened and either or both may be increased, decreased, or affirmed. A

separate application must be made for each parcel.

Any appraisal report or professionally prepared opinion of value submitted with this application must be complete as originally prepared. Partial

reports will not be considered as valid evidence of value. Such valuation reports or opinions must be signed by the original preparer.

Form Revised 2/2004