Docket No.______________________________________________________________

PETITION FOR ARBITRATION

Taxpayer _______________________________________________________________

vs. Larimer County Board of Equalization

1. The undersigned property owner, pursuant to Section 39-8-108.5, C.R.S., requests arbitration.
2. Petitioner (will) (will not) be represented by an attorney. Petitioner's attorney's name, address and telephone number are:

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3. The subject property is located in Larimer County with address or legal description as follows:

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   with tax schedule number ____________________________,

   and parcel number __________________________________.

4. That the property is (residential real property) (other property).
5. That the residential arbitration fee in the amount of $150.00 is hereby advanced, to be held in trust pending a decision of the arbitrator; OR

   That, for other property, I will contact the County Assessor within ten (10) days to determine an estimated fee for arbitration which will be deposited with the Clerk and Recorder pending a decision by the arbitrator; OR

   An application for fee waiver based upon indigence of the petitioner is pending before the Board of County Commissioners.

6. That _____________________________________be named and assigned as arbitrator.
7. That the following issues are in need or arbitration:

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   Signature                                   Date
   Name
   Address
   Telephone
   
   Print this form
   and mail to:  Larimer County Commissioners
                 PO Box 1190, Fort Collins, CO  80522