Provinding additions and beterments to Vader Water System Utility Office Use Only Taxpayer Petition to the
Petition. ♦ - 2i 2 Lewis County Board of Equalization for
Date Received: Review of Real Property Valuation Determination
This petition must be filed or postmarked by July 1 of the current assessment year or 30 days after the date of mailing of the
change of value or other determination notice(up to 60 days in those counties that the Legislative Authority has extended the
deadline) If filing after July 1, a copy of the determination notice must be attached to this petition.
The undersigned petitions the Board of Equalization to change the valuation of the property described below as shown on
the assessment roll for 2018 for)axes payable in 2019 to the amount sn in Item 3(b)on this form
Please Complete All Items(Please Print) LL V I V�
1 Account/Parcel Number: t over 400 D. DEC 2
2 Owner. 3o�+h ���
Mailing Address for All Corresponde ce Relatin to Appeal: LEWIS COUNTY
Street address. ` Mc,C lwr DARD OF EQUgLIZgT!P
City, State,Zip Code. W V' OC.0 w cis 5ctL
May we contact you by email? ❑ Yes 1= No E-mail address.
Daytime Phone No: -3(v.) ','1 q' (" • Fax No.
Name of petitioner or authorized agent: tif' ' •
3 Assessor's determination of true& fair value. (b) Your estimate of true& fair value.
Land.... .. .. .. .... $ IL-1,10o Land . . . . $ 14•-too
ImprovementBldgs .. . $ 331, yG° ImprovementBldgs . $ 300,600
TOTAL $ 34. (0O TOTAL ... . .$ 3 14 1 ZO()
Date the assessor's"Change of Value Notice"or other determination notice was mailed
I request the information the assessor used in valuing my property ® Yes ❑ No
4. Specific reasons why ou believe the assessor's v lue does not reflect the true and fair market value.
14-00.5e loco eak cr C>�'•( �e r,' Rd• ski to for r actoed
-� VCr, 114 4( VaLur
s22
NOTE: Under Washington law,you must prove that the assessor's value is not the true and fair market value
(RCW 84.40.0301) If this petition concerns income property,please attach a statement of income and expenses
for the past two years and copies of leases or rental agreements
Other issues relevant to your case:
5. Power of Attorney. If power of attorney has been given, the taxpayer must so indicate by signing the statement below
or attaching a signed power of attorney
The person whose name appears as authorized agent has full authority to act on my behalf on all matter pertaining to
this appeal.
Signature of Petitioner(Taxpayer)
I hereby certify I have read this Petition and that it is true and correct to the best of my knowledge.
Signed this day of DeCcbe- , 0201$
REV 64 0075e(3/27/2018) Signa a of Taxpayer or A nt