DECLARATION OF REPRESENTATIVE
Property Owner(s) Name(s) as it appears on the Change of Value Notice
Property Owner's Mailing Address (Street, PO Box, City, State, Zip Code)
Property Owner's Telephone Number
hereby appoints the following individual, corporation, limited liability company, organization, firm or partnership Individual Representatives Name and Title
If applicable, provide Corporation, Limited Liability Company, Organization, Firm or Partnership Name
Representative's Mailing Address (Street, PO Box, City, State, Zip Code)
Representative's Telephone Number
To represent the above named property owner before the State Court of Tax Appeals pursuant to the Court's rules and regulations for property located in _______________________ County for the _____________________ tax year(s). ____________________________________________________ Signature of Property Owner _____________________________ Date
If signing on behalf of a corporation, limited liability company, organization, firm or partnership, provide below the printed name and title of person signing. ____________________________________________________ Printed Name ______________________________ Title
CTA Revised 07/2008