Form 11 R/a (State 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 (R5 / 1-02)
Prescribed by Department of Local Government Finance
This notice indicates the assessed value of your property. Information on the valuation of your property and a copy of the property record card can be
obtained from the Township Assessor at the telephone number and address below. 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
NEW ASSESSMENT EFFECTIVE MARCH 1, _______
PREVIOUS ASSESSMENT AT 100% OF TRUE TAX VALUE
LAND
LAND
STRUCTURES
STRUCTURES
TOTAL
TOTAL
Reason for revision of assessment:
Township
County
Date of notice
Township Assessor
Telephone number
(
)
Address (number and street, city, state, ZIP code)
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