NO. % COMPOSITION FORCED AIR CARPET: SWIMMING POOL CONCRETE ST. (GAS/ELECTRIC) TENNIS COURT . WOOD SHINGLE SPACE HEATERS HARDWOOD: 1 STORY SINGLE ELVATOR SHELL/GRAVEL % OR WALL FURNACE WOOD SHAKE GREEN HOUSE ELECTRICITY CERAMIC TILE: 2 STORY SINGLE LAWN SPRINKLER PUBLIC WATER WARM AND COOLED AIR % BUILD UP TAR BOAT HOUSE GAS AND GRAVEL HEAT PUMP PIER PUBLIC SEWER VINYL: 1 STORE DOUBLE SLATE OR TILE % SMOKE ALARM SEPTIC TANK SOLAR TIN OR METAL STONE: 2 STORY DOUBLE RADIO/INTERCOM WELL % OTHER: OTHER: OTHER: OTHER: OTHER: OTHER: % ADDITIONAL LIVEABLE IMPROVEMENTS EXPLAIN – SIGNATURE AND VERIFICATION I declare under the penalties for filing false reports that this return has been examined by me and to the best of my knowledge and belief is a true, correct and complete return. If the return is prepared by other than the taxpayer, his declaration is base on all information relating to the matters required to the reported in the return of which he has knowledge. SIGNATURE OF TAXPAYER DATE (ATTACH RECENT PHOTOGRAPH OF BUILDING) PRINTED/TYPED NAME OF TAXPAYER
COMPOSITION WOOD SHINGLE WOOD SHAKE BUILD UP TAR AND GRAVEL SLATE OR TILE TIN OR METAL OTHER: FORCED AIR (GAS/ELECTRIC) SPACE HEATERS OR WALL FURNACE WARM AND COOLED AIR HEAT PUMP SOLAR OTHER: CARPET: HARDWOOD: CERAMIC TILE: VINYL: STONE: OTHER: % % % % % % NO. 1 STORY SINGLE 2 STORY SINGLE 1 STORE DOUBLE 2 STORY DOUBLE OTHER: SWIMMING POOL TENNIS COURT ELVATOR GREEN HOUSE LAWN SPRINKLER BOAT HOUSE PIER SMOKE ALARM RADIO/INTERCOM OTHER: CONCRETE ST. . SHELL/GRAVEL ELECTRICITY PUBLIC WATER GAS PUBLIC SEWER SEPTIC TANK WELL OTHER: ADDITIONAL LIVEABLE IMPROVEMENTS – EXPLAIN SIGNATURE AND VERIFICATION I declare under the penalties for filing false reports that this return has been examined by me and to the best of my knowledge and belief is a true, correct and complete return. If the return is prepared by other than the taxpayer, his declaration is base on all information relating to the matters required to the reported in the return of which he has knowledge. (ATTACH RECENT PHOTOGRAPH OF BUILDING) SIGNATURE OF TAXPAYER DATE PRINTED/TYPED NAME OF TAXPAYER