Form Pt-455 - Appeal For Real Property Assessment County Assessor (Page 2 of 2) in pdf

Form Pt-455 - Appeal For Real Property Assessment County Assessor Page 2

Section IV: Information and Support for Protest

State all the reasons you disagree with the assessor, including a statement of the facts supporting your position and the

law or other authority on which you rely. You may attach additional pages if necessary.

Taxpayer's Signature

Date

Co-owner's Signature

Date

Instructions

The purpose of this form is to reduce to writing those facts and issues with which you disagree. A protest may be

filed by letter rather than using this form; however, all of the information required by this form must be included in the

letter and you must comply with the requirements concerning signatures. If the protest is for a corporation, it must

include the corporation's name followed by the signature and title of the corporate officer authorized to sign. If you

have any questions concerning this matter, please call the telephone number on the notice or document with which you

disagree. Please return the protest to the county assessor at the address shown on the notice or document with which

you disagree.

Social Security Privacy Act Disclosure

It is mandatory that you provide your social security number on this tax form. 42 U.S.C 405(c)(2)(C)(i) permits the use

of an individuals social security number as means of identification in administration of any tax. Your social security

number is used for identification purposes.

Form Pt-455 - Appeal For Real Property Assessment County Assessor Page 2