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               CERTIFICATION BY COUNTY ASSESSOR
               (of Railroad and Public Utility Assessments)                                                            FORM 34C
               State Form 18602 (R4 / 12-15)
               Prescribed by the Department of Local Government Finance

INSTRUCTIONS:
1.  List by taxing district the total assessed value of all locally assessed real estate and personal property of railroads and public utility companies.
2.  Use a separate sheet for each company reported.
3.  File completed forms with the Department of Local Government Finance by April 10.
Assessment date:                                                       County
                             January 1, 20 ______
Name of Company (Railroad, Telephone, Pipeline, Utility, etc.)                                  FEIN

Type of utility
Electric            Gas            Water            Sewage            Pipeline            Telephone            Bus            REMC            Railroad            Rail car
Name of Township and Taxing District                                   DLGF Taxing District No. Total Real Property    Personal Property

I certify that this report is true, correct and complete, and represents the assessed valuation of the property in question as of January 1, 20______ .
Signature of County Assessor                                                                    Date (month, day, year)