I hereby request partial exemption from real estate taxes for qualifying property to be rehabilitated as provided by County Ordinance Section 9-14.3 of the Campbell County Code. * I agree. Owner Name * Property Location * Parcel ID Year Built * Estimated Cost of Work * Description of Work to be Completed * Copy of Appropriate Building Permit Attached * Files must be less than 5 MB.Allowed file types: gif jpg jpeg png pdf doc. Mailing Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Telephone Number * Email Address * Commercial or Industrial Application Fee - $100* * Check, cash or credit card *This form serves as a preliminary application upon receipt. Application is not complete until payment is collected. Payment Options: Checks may be mailed to Campbell County Real Estate; cash or credit card may be paid in person at Campbell County's Real Estate or Community Development Offices. I certify that the statements contained in this application are to the best of my knowledge both correct and true and that I have received a copy of the aforementioned ordinance. I have reviewed and understand the requirements of the program. * I agree. Official Use Only Application No. Date of Initial Inspection Appraiser Base Value Date of Final Inspection Appraiser Rehabilitation Value Permit No. Amount of Exemption (if qualifying) Date Exemption Effective January 1, Exemption Ends December 31, QC: Property ID Verified QC: Year Built Verified QC: Building Permit Attached QC: Verify Taxes Current QC: Signed & Dated Leave this field blank