Beverly Stivers
101 Ollie J Bowen Street
Lawrenceburg, KY 40342
Phone: 502-839-4061 FAX: 502-839-8151

Please complete this form, print it, and return it with your check to the Property Valuation Administration Office, 101 Ollie Bowen Plaza, Lawrenceburg, KY 40342

First Name:
Last Name:
Company Name:
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	Number of Records. Check one. 10 Records per month for 12 months - $100 25 Records per month for 12 months - $200 50 Records per month for 12 months - $400 100 Records per month for 12 months - $750