(To print this page, go to FILE, and select PRINT. Mail or hand deliver to the Commissioner of the Revenue)

APPLICATION TO THE BOARD OF EQUALIZATION

                             County of Buckingham
                       P O Box 138, Buckingham, VA 23921
                              Phone: 434-969-4181
                              Fax:  434-969-2753

DATE APPLICATION RECEIVED:_______________.

(Use one form for each parcel appealing):

OWNERS NAME_________________________________________(As Listed On Land Book)

OWNERS ADDRESS______________________________________

Address of Property if Different from above:

____________________________________________

Tax Map Number: ____________________________

Reason for Appeal (Check): (  ) Land Value; (  ) Building Value; (  ) Total Value;

REQUIRED:

__________________________________________________ Date:____________________     Signature of Owner, Taxpayer or Officer of Company

Telephone (home)_____________________________________(work)__________________

(Agent or Representative appearing on behalf of the property owner:  A signed letter of authorization by property owner must be submitted along with
application for review).

                             Optional Information:

Other reasons: __________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

List comparable or similar properties for Board to review:(Tax Map Number & owner)

  1)____________________________________________________________

  2)____________________________________________________________

Date of Hearing:________________;  Time of Hearing:____________.

NOTE:  APPLICANT SHOULLD NOTE THAT THIS APPEAL IS TO BE BASED SOLELY ON UNEQUAL ASSESSMENTS ON LIKE PROPERTIES (NOT THE TAX RATE OR THE ASSESSMENT ITSELF).