Homeowner's Questionnaire

Linn County - Assessor's Office

If an inspection is not possible, please complete this form and submit to the Linn County Assessor's Office. It will assist us in verifying the information for your property. Thank you for your cooperation.

Parcel Number:	11323-55040-00000
Address:	165 17TH AVENUE CT HIAWATHA, IA 52233-2066
Class:	Residential
Neighborhood:	3-Hiawatha- Res
Deedholder:	GOLDSMITH KATHLEEN J & RONALD J
Contract:
Mailing Address:	165 17TH AVENUE CT HIAWATHA, IA 52233-2066

PROPERTY LISTING

		Is listing correct? If No, explain:
Exterior Walls:	Vinyl	Yes * No * Response required.
Total Living Area (SF): Above Ground	1,613	Yes * No * Response required.
Total Bsmt Finish (SF):	1,110	Yes * No * Response required. Please describe basement finish: Response required.
Flooring:	Carp/Vinyl/Hdwd/Ceramic	Yes * No * Response required.
Total # Rooms:	8	Yes * No * Response required.
Total # Bedrooms:	4	Yes * No * Response required.
# of Baths:	2.25	Yes * No * Response required.
Central Air Conditioning:	Yes	Yes * No * Response required.
Heat:	FHA - Gas	Yes * No * Response required.
Fireplace:	1	Yes * No * Response required.
Garage:	1	Yes * No * Response required. If interior of garage is finished, please describe: Response required.

GENERAL QUESTIONS

Overall condition of the property, in your opinion:

Excellent *

Above Normal *

Normal *

Below Normal *

Poor *

Condition Comments:

Is your property sketch below correct? Review Sketch Abbreviations

Yes *

No *

Sketch Explain:

Response required.

Are there any other changes to the property? (ie: remodel, renovation, new buildings,
new additions, new construction, demolition, removal, other)

Would you like an appraiser from this office to contact you for a review of this property?

Yes *

No *

Would it be OK to have the appraiser stop by property to do an exterior inspection and update photos?

Yes *

No *

Owner's Name:

Response required.

Date:

Enter today's date.

Response required.

Daytime Telephone Type:

Work *

Home *

Cell *

Telephone Number:

Format: (321) 456-7890

Response required.

Email Address:

Response required.

DECLARATION AND SIGNATURE

Iowa State Code - Chapter 441: http://www.legis.state.ia.us/IACODE/1999SUPPLEMENT/441/

The assessor shall list every property in the assessor's county or city as the case may be and assess all the property in the county or city, except property exempted or otherwise assessed. A person who refuses to assist in making out a list of the person's property, or of any property which the person is by law required to assist in listing, is guilty of a simple misdemeanor.

For additional information, refer to: http://linn.iowaassessors.com