Good Cause Request
VALUE ADJUSTMENT BOARD
REQUEST TO EXTEND THE PETITION FILING DEADLINE
(Must be filed no later than December 31, NO exception will be made!)
Print Three Copies: VAB Copy, PAO Copy, Petitioner's Copy
Type of petition requesting:
Person to Contact:
Address:
City, State, Zip:
Phone (Day): Evening:
E-mail:
Homestead Exemption
Senior Exemption
Widow / Widower
Disability $500
Veterans Disability $5,000
Total Disability
Agricultural Classification
Non-Profit Classification
Valuation
List the real estate number(s):
Please return copies to: Value Adjustment Board
Your County
Signature of Petitioner:
Give reason for not filing petition timely: You must fully explain your extenuating circumstances. The
decision to grant or deny your request will be based on your written statements. Your request must only
address your reasons for not filing your petition prior to the filing deadline of September 20, 2004.
Use as much space as needed.
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