Before The Board Of Tax Appeals Of The State Of Kansas Payment Under Protest-Illegal Levy
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3BEFORE THE BOARD OF TAX APPEALS OF THE STATE OF KANSAS
PAYMENT UNDER PROTEST-ILLEGAL LEVY
(K.S.A. 79-2005)
APPLICANT:
(For State of Kansas use only)
__________________________________________
Applicant Name (Owner of Record)
__________________________________________
Applicant Address (Street or Box No.)
__________________________________________
City
State
Zip
DOCKET NO.______________________-PR
Applicant Phone #:(____)_____________________
Fee:_____________
Amt Rec.__________
Applicant E-mail:___________________________
Rec. Date:________
Ck #______________
ATTORNEY OR REPRESENTATIVE: (If applicable)*
No Fee:__________
Reason: ___________
__________________________________________
Representative Name
Title
__________________________________________
Representative Address
(For County use only)
__________________________________________
City
State
Zip
Parcel ID #/Personal Property ID #
or Vehicle ID #:
_____________________________________
Atty/Rep Phone #:(_____)_____________________
_____________________________________
Representative E-mail:________________________
_____________________________________
Taxing County:_____________________________
Year/Years at issue: _________________________
County’s valuation: $____________________
Small Claims Division:____ or Regular Division: ____
LBCS Function Code: ___________________
Property at issue:
Real Property---Street address, city:_____________________________________________________
Personal Property---Description: _______________________________________________________
CTA-PR (Rev. 7/14)
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