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PETITION TO THE STATE BOARD OF ASSESSMENT APPEALS
Date: Plus LS t 15 , 19 R I
BOARD OF ASSESSMENT APPEALS:
Your Petitioner, ft-1OA. 6um 'Sim + &Ask Kull. + Sl ng Son
J (name of property owner)
Roo 3tst ai-reet Eves\ C Sou 1O
(street address, City, State, Zip Code of subject property)
hereby appeals the decision of the (check one of the following)
X County Board o£ Equalization, _County Board of Commissioners or
Property Tax Administrator dated A-L,_o LS} a , 199I , for property
located in the county of wend concerning (check one
of the following) X Valuation _Refund _Exemption _Abatement for the
tax year(s)
COUNTY SCHEDULE NUMBER OR PARCEL NUMBER: 0%12_030 Roo-]
(Make sure that your appeal includes a complete legal description of the
subject property(ies) . If multiple properties are involved, a list of
schedule numbers must be attached. )
PROPERTY CLASSIFICATION: This property is classified as: (Please check
one of the following)
)( commercial _Personal Property _Residential _Vacant land
_Industrial _Agricultural _Natural Resources _Producing Mines
_Oil and Gas _State Assessed _Exempt
' ATTACHMENTS TO THIS PETITION FORM: (Please check off the required
attachments)
X The decision being appealed.
A notarized .letter of authorization if an agent is filing for or
representing a petitioner.
The Assessor's Notice of Denial or Notice of Valuation.
Statement o£ issues involved in this appeal.
ESTIMATED TIME FOR PETITIONER TO PRESENT THE APPEAL:
too minutes or i hours
REPRESENTATION: (Please check appropriate responses)
Petitioner will be present at the hearing.
Petitioner requests that the Board rule on the documentation
submitted. Telephone conference call will be required.
Petitioner will be represented by an agent.
_(_Petitioner will be represented by a Colorado Attorney.
Please inform the Board in writing if representation changes are made
prior to hearing.
1
/kC aa` 911916
•
. .
CERTIFICATE OF SERVICE
I certify to the Board of Assessment Appeals that I have mailed or
hand delivered one complete copy to the (indicate one
(County Name)
of the following) X County Board of Equalization, _County Board of
Commissioners, or _Property Tax Administrator in ceelc
.� 30 , 159 (city
Colorado, on
DILI;C. &re n' , A me
*Attorney or Agent for Pdtitioner Petitioner's signature
Rem . No. 150..) 5
Att•_'ney's or Agent's Address Petitioner's mailing address
Pbsi- n{ rr. gox 11e2
Love I C nrt_ Cf) R05,39
303- 1009-.32-03 / 303- 144-n4.3t�
Attorney's/Agent s Telephone No. Petitioner's Telephone No.
*Please indicate whether this is an attorney or an agent.
Please fill out attorney information only if a Colorado attorney will
be representing you at the hearing. An attorney may be retained at any '
time subsequent to filing appeal; however, if an attorney is later
retained, an entry of appearance is required prior to hearing.
T10/petition. frm
BAA-1/Rev. 91
J 2
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