Form Tc-104 - Stipulation & Order Of Approval Page 3

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Appeal No.
PARCEL ___________________
Prior Market Value
Stipulated Market Value
Primary
Secondary
Primary
Secondary
Land
$____________
$____________
$____________
$_____________
Buildings/
Improvements
$____________
$____________
$____________
$_____________
TOTAL
$
$
$
$_____________
Greenbelt
$____________
$____________
$_____________
$_____________
PARCEL___________________
Prior Market Value
Stipulated Market Value
Primary
Secondary
Primary
Secondary
Land
$____________
$____________
$____________
$_____________
Buildings/
Improvements
$____________
$____________
$____________
$_____________
TOTAL
$
$
$
$_____________
Greenbelt
$____________
$____________
$_____________
$_____________
PARCEL____________________
Prior Market Value
Stipulated Market Value
Primary
Secondary
Primary
Secondary
Land
$____________
$____________
$____________
$_____________
Buildings/
Improvements
$____________
$____________
$____________
$_____________
TOTAL
$
$
$
$_____________
Greenbelt
$____________
$____________
$_____________
$______________
Petitioner’s Initials: _____________
Respondent’s Initials: _____________
TC-104 Rev. 5/13
page 3

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