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2. St. Charles County Assessor's Office
   Occupancy Taxation Division
   201 N. 2nd St.
   Suite 215
   St. Charles, MO 63301
   Ph: 636-949-7445
   Ph: 636-949-7444
   Fx: 636-949-7436
4. ID Number
5. Account Number
7. Builder's Name
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Legal Description
19. The above referenced property is a display / specification home and has not been occupied at any time as a residence; it will be fully taxable on the first day of January of the fourth year following the year in which construction was complete.
    
    By the Assessor's recognition of this property as a display / specification home, the builder hereby agrees to notify the Occupancy Department of the St. Charles County Assessor's Office of the new owner name, address, and the date this property becomes occupied as a residence. Failure to make prompt notification to the Assessor's Office could result in a liability for back taxes.

    1. By typing my name on the line below, I have attached my signature electronically to this form.
21. Builder Signature
23. Address1
25. Address2
27. City
28. State
29. Zip
31. Phone Number
32. Date
    Date
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