Form Cta-Pvx - Property Valuation Exemption Page 3
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VERIFICATION
I, ________________________________, do solemnly swear or affirm that the information set forth herein is
true and correct, to the best of my knowledge and belief. So help me God.
_____________________________________
Signature of Applicant
_____________________________________
Printed Name and Title
State of ____________________
)
County of __________________
)
This instrument was acknowledged before me on __________ by ______________________________.
Seal
_____________________________________
Signature of Notary Public
My appointment expires: ________________
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Parent category: Financial