Assessor Eligibility Questionnaire Form Page 3
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4Assessor Eligibility Questionnaire
Page 3
PArt ii
(continued)
Employer’s Name and Address
Dates of Employment
Your Title
Supervisor’s Name
Description of Accounting Duties
Description of Management Duties
Employer’s Name and Address
Dates of Employment
Your Title
Supervisor’s Name
Description of Accounting Duties
Description of Management Duties
Signature
Date
X
150-800-065 (Rev. 07-07)
Sign, date, and return your completed questionnaire to the Department of Revenue.
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