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Property Valuation Protest
FORM
FIle wITh The
COuNTy CleRk
and Report of County Board of Equalization Action
422A
(See Instructions)
County Name
NAME AND MAILING ADDRESS OF PERSON FILING PROTEST
Protest Number
Filed
Name
______________________, 20 _____
Protested Valuation 20 ____
Requested Valuation
Street or Other Mailing Address
Real Property
Real Property
$
$
City, Town, or Post Office
State
Zip Code
Personal Property
Personal Property
Property Identification Number
Telephone Number
$
$
Reasons for requested valuation change (Attach additional pages if needed.)
Real Property Description (Include lot, Block, Addition, location Address, Section,
Township, Range, and County) and/or Personal Property Description
sign
here
Signature of Person Filing Protest
Date
County Assessor’s Recommendation
Referee’s Recommendation (If applicable)
Decision of County Board of Equalization for Assessment Year 20 ____
Basis for Action Taken (County Board of equalization Chairperson)
Real Property
$
Personal Property
$
Check One:
Attached is a copy of that portion of the property record file which substantiates
The county assessor has certified to the county board of equalization that a copy
the calculation of the protested value. If dissatisfied with the board’s decision, this
of that portion of the property record file which substantiates the calculation of the
report and the property record file may be used to complete an appeal to the Tax
protested value is maintained in the county assessor’s office in electronic or paper
equalization and Review Commission.
form. If dissatisfied with the board’s decision, this report and the property record file
may be used to complete an appeal to the Tax equalization and Review Commission.
Signature of County Board Chairperson
Date
County Clerk Certification
Date the Protest was heard
Date of the Decision
Date Notice of Decision was Mailed to Protestor
The undersigned certifies that a copy of this protest and report of the action of the county board of equalization, which has been accepted by the assessor, has
been mailed to the protestor at the above-shown address on ___________________________________, 20____.
Date
Signature of County Clerk
Nebraska Department of Revenue
Authorization by Neb. Rev. Stat. §77-1502
96-245-2004 Rev. 5-2011 Supersedes 96-245-2004 Rev. 3-2009