Please complete this form, print it, and return it with your check to the Property Valuation Office, 116 N. Main Street, Suite 1, PO BOX 530, Nicholasville, KY 40340.
First Name:
Last Name:
Company Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
	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