OCR Scan (approximately)

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REAL ESTATE ASSESSMENT OFFICE
COUNTY OF RUSSELL
PO BOX 517
LEBANON, VA 24266
DOUBLEWIDE BUILDING ONLY
NAME ON TITLE OF DOUBLEWIDE.
ADDRESS OF DOUBLEWIDE OWNER,
LAND OWNER NAME,
‘TAX MAP NUMBER
‘SERIAL NUMBER OF DOUBLEWIDE,
YEAR MODEL AND SIZE OF DOUBLEWIDE
SIGNATURE OF LAND OWNER,
‘SIGNATURE OF DOUBLEWIDE OWNER,
DATE,
FAILURE TO PAY TAXES ON BUILDING ONLY CARDS WILL
RESULT IN BEING REMOVED FROM LAND USE PROGRAM.
FINAL RESPONSIBILITY OF TAXES FALL ON LAND OWNER.