Certification for Special Assessment (Office of Building, Planning, & Code Compliance, City of Knox, Indiana) Instructions

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This form contains 19 fields organized into 10 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Certification Signature Block
Certification Date Date
Enter the date when the certification is signed or completed.
Max length: 18 characters
Prepared By (Name/Title) Text
Enter the full name (and optionally title) of the person who prepared this certification.
Max length: 28 characters
Certifier Signature / Printed Name Text
Enter the certifier's printed name or signature (the person affirming the information, e.g., Lonnie Boley).
Max length: 31 characters
First Unpaid Cost Row
First Invoice Number Text
Enter the invoice number or identifier for the first unpaid cost listed.
Max length: 17 characters
First Invoice Date Date
Enter the invoice date associated with the first unpaid cost.
Max length: 17 characters
First Amount Due Number
Enter the unpaid monetary amount due for the first invoice.
Max length: 18 characters
Form Date
Form Date Date
Enter the date on which this certification form is being completed.
Max length: 30 characters
Legal Description
Legal Description Text
Enter the full legal description of the property (for example: lot, block, subdivision, or metes and bounds) exactly as it appears on the deed or title documents.
Max length: 68 characters
Owner Name(s)
Owner Name 1 Text
Enter the full legal name of the first property owner or the primary owner on record; for businesses, enter the business/legal entity name.
Max length: 81 characters
Owner Name 2 Text
Enter the full legal name of the second property owner or co-owner (if applicable); for businesses, enter the additional business/legal entity name.
Max length: 81 characters
Parcel Number
Parcel Number Text
Enter the property's assessor parcel number (APN) or parcel ID exactly as it appears on tax records or your deed.
Max length: 71 characters
Property Address
Property Address Text
Enter the full property address including street number and name and, if applicable, unit or suite, city, state, and ZIP code.
Max length: 68 characters
Second Unpaid Cost Row
Second Invoice Number Text
Enter the invoice or reference number for the second unpaid cost line.
Max length: 17 characters
Second Invoice Date Date
Enter the date shown on the invoice for the second unpaid cost line.
Max length: 17 characters
Second Amount Due Number
Enter the amount due for the second unpaid cost line as a numeric value.
Max length: 18 characters
Third Unpaid Cost Row
Third Invoice Number Text
Enter the invoice or reference number for the third unpaid cost entry exactly as it appears on the billing or invoice document.
Max length: 17 characters
Third Invoice Date Date
Enter the date shown on the invoice for this third unpaid cost entry.
Max length: 17 characters
Third Amount Due Number
Enter the unpaid amount owed for this invoice (the third unpaid cost entry).
Max length: 18 characters
Total Due
Total Due Number
Enter the total amount currently due for unpaid costs and penalties listed on this certification.
Max length: 19 characters