Self-Reporting Assessment Form Please complete this form if you received a pink tag at your property, stating that an appraiser was at your property. Name(Required) First Last PID #(Required)On pink slip or tax statement. Listed as PRCL# on tax statement Phone(Required)Best time to reach you?In the event we have any questions on the information submitted. Type of HouseStick BuiltPole TypeSingle WideDouble WideModularYear build of house, if known House addition years, and Square Foot of addition, if knownHouse InteriorPlease indicate how many of the following you have per level. For flooring types, indicate how many rooms per level have that type of flooring, if applicable. Living Room Basement/Lower Level First Story/Main Level Second Story/Above Main Kitchen Basement/Lower Level First Story/Main Level Second Story/Above Main Bedrooms Basement/Lower Level First Story/Main Level Second Story/Above Main Full Bathrooms Basement/Lower Level First Story/Main Level Second Story/Above Main Half Bathrooms Basement/Lower Level First Story/Main Level Second Story/Above Main Laundry Area Basement/Lower Level First Story/Main Level Second Story/Above Main Fireplace Basement/Lower Level First Story/Main Level Second Story/Above Main Laminate Floor Basement/Lower Level First Story/Main Level Second Story/Above Main Tile Floor Basement/Lower Level First Story/Main Level Second Story/Above Main Harwood Floor Basement/Lower Level First Story/Main Level Second Story/Above Main Miscellaneous FeaturesSelect all that apply Quartz/Granite/Tile Countertops Kitchen/Bathroom Tile Backsplash Vaulted Ceiling One Room Vaulted Ceiling Multiple Rooms Recessed Lights One Room Recessed Lights Multiple Rooms Wood Wall/Ceiling Finishing Solid Panel Doors Stained Concrete Floor Interior Fireplace Surround Indoor Pool Heat TypeSelect all that apply Forced Air Electric Baseboard GEO Thermal Floor/Wall furnace Hot Water Gravity Heat Pump In-Floor Heat Space Heater No Heat Other Heat FuelSelect all that apply Natural Gas Propane Fuel Oil Electric Wood Other Electrical Breaker box Fuse box Knob/tube Other Electrical Amperage 50 Amp 100 Amp 200 Amp 250 Amp Other Other Other PlumbingOriginalPartially ReplacedTotally ReplacedBasement Finish Amount0%25%50%75%100%Basement FinishSelect all that apply Electric Wall Heat In-Floor Heat Under 8' Ceiling Height 8' Ceiling Over 8' Ceiling Height Wood Ceiling False/Grid Ceiling Drywall Ceiling Entire Basement Open (No Walls) Few Walls/Rooms Several Walls/Rooms Drywall Walls Panel Walls Wood Walls No Floor Covering Stained Concrete Floor Dry Bar Wet Bar Theater Room Wine Cellar Sauna House Updates or RemodelPlease enter approximate year of update or remodelFoundation Siding Roof Heating A/C Windows Total Kitchen Remodel Kitchen Cabinets Remolded Bathroom Insulation/Sheetrock Floor Covering Electrical System Plumbing System GarageStick BuiltPole TypeYear built of garage, if known Garage Interior FinishSelect all that apply Insulated Lined Forced Air Heat In-Floor Heat No Concrete Floor No Electricity A/C Basement Access Epoxy/Tile Floor Kitchen Mezzanine Floor Drain(s) Plumbing/Bathroom Bonus Room Above Garage Additional Comments/InformationPlease note any additional buildings other than the house & garage with interior finish and year built.CAPTCHA
