BOARD OF ASSESSMENT APPEALS WESTMORELAND COUNTY 40 NORTH PENNSYLVANIA AVE, SUITE 440 GREENSBURG, PA 15601 (724) 830-3408 FAX: (724) 830-3852 SSESS ( A completed and signed DATE: ATION Appeal Form must be returned to our office on or before Faxed or emailed copies are not accepted.) I (we) hereby in property situated (Twp. / Borough / City). <> The property is known as (please give proper street address) The property is located (please give directions from Court House) TAX MAP NUMBER: (Number is noted on your - - - - - - or call 724-830-3409 Tax Assessment Office for assistance.) A separate completed and signed form is required for each Tax Map Number GO TO PAGE TWO **DO NOT WRITE BELOW THIS LINE** TED: _________________ RECEIVED: _______________________ HEARING DATE: _________________________________________ TIME: __________________ (a.m./p.m.) POSTPONED: _______ WITHDRAWN: ______ ABANDONED: ________ HEARING HELD: ________ ADMINISTRATIVE REVIEW: ________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com PLEASE ANSWER ALL QUESTIONS Attach Additional Documentation If Necessary 1. The owner of the property is _____________________________________________________________. 2. The deed was recorded _________ in Volume _____ Page _____ or Instrument No. ________________. 3. Describe the property __________________________________________________________________ ____________________________________________________________________________________ 4. What use is made of the Property? (Please explain all uses.) ____________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 5. When did such use begin? _______________________________________________________________ 6. Does anyone reside on the property? Yes No If so, who and why? _____________________ _____________________________________________________________________________________ 7. Is any revenue derived from the property? Yes No If so, what is the revenue used for? _____________________________________________________________________________________ 8. Are all the real estate taxes paid for the current and past years? Yes No 9. Under what sub-section(s) of the Pennsylvania Exemption Statute are you applying? _________________ _____________________________________________________________________________________ 10. If this application is for religious use, when was the property first used for regularly stated religious services? ______________________________________________________________________________ If the property is owned by a corporation, an officer must sign. Signature _____________________________________ Title _____________________________ ******DO NOT FORGET TO PRINT AND SIGN****** CONSIDERED Name Printed _________________________________________ APPLICATION MUST BE SIGNED IN ORDER TO BE Address _____________________________________ _____________________________________ Telephone Number _______________________ Alternate Number _______________________ APPLICATION MUST CONFORM TO SECTION C OF THE RULES OF APPEAL PROCEDURE. If you are claiming to be a purely public charity under Act 55, please include the following documents: IRS Schedule A Form 990; last 2 years Financial Statements; most recent Pennsylvania Tax Exemption Certificate. The Board may schedule a hearing to gather additional information with respect to your request. All Exemption Applications will be considered by the Board at a public meeting. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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