PAYMENT UNDER PROTEST APPLICATION
(Excluding Illegal Levy)
(K.S.A. 79-2005)
APPLICANT:
__________________________________________
Applicant Name (Owner of Record)
__________________________________________
Applicant Address (Street or Box No.)
__________________________________________
City State Zip
Applicant Phone #:(____)_____________________
ATTORNEY OR REPRESENTATIVE: (If applicable)*
__________________________________________
Representative Name Title
__________________________________________
Representative Address
__________________________________________
City State Zip
Atty/Rep Phone #:(_____)_____________________
*Note: If you are represented by an attorney or
other individual, you must provide an Entry of Appearance
or a current Declaration of Representative Form.
Taxing County:_____________________________
Year/Years at issue: _________________________
Property at issue:
Real Property---Street address, city:_____________________________________________________
Personal Property---Description: _______________________________________________________
BTA-PR (Rev. 7/14)
(For Official use only)