Form 422 - Property Valuation Protest And Report Of County Board Of Equalization Action

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Property Valuation Protest

FORM

FILe wITH THe

422

COuNTy CLerk

and Report of County Board of Equalization Action

(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

Land

City, Town, or Post Office

State

Zip Code

Buildings

Property Identification Number

Telephone Number

Total Land and Buildings

(

)

real Property Description (Include Lot, Block, Addition, Location Address, Section,

Personal Property

Township, range, and County) and/or Personal Property Description

reasons for requested valuation change (Attach additional pages if needed.)

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)

Land

Buildings

Total Land and Buildings

Personal Property

Check One:

The county assessor has certified to the county board of equalization that a copy

Attached is a copy of that portion of the property record file which substantiates

of that portion of the property record file which substantiates the calculation of the

the calculation of the protested value. If dissatisfied with the board’s decision, this

protested value is maintained in the county assessor’s office in electronic or paper

report and the property record file may be used to complete an appeal to the Tax

form. If dissatisfied with the board’s decision, this report and the property record file

equalization and review Commission.

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

96-199-2000 rev. 5-2011 Supersedes 96-199-2000 rev. 3-2009

Authorized by Neb. rev. Stat. § 77-1502