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               CERTIFICATION BY TOWNSHIP ASSESSOR
               (of Railroad and Public Utility Assessments)                                                             FORM 34T
               State Form 18603 (R4 / 12-15)
               Prescribed by the Department of Local Government Finance                          Assessment date:
                                                                                                                        January 1, 20 ______
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 County Assessor by April 1.
County                                                                  Township

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 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 Township Assessor                                                                   Date (month, day, year)