Dwelling Interior Survey

Wayne County - Assessor's Office

The Assessor’s Office is providing this form in an attempt to help property owners comply with Iowa Code Sec 441.19. The law requires all property owners report any new construction and/or improvements to the Assessor’s Office. Providing this information ensures the accuracy of our records and your assessment. Please complete this form and return it to the Assessor’s Office. Thank you for your cooperation.

Owner's Name:

Required field.

Email Address:

Required field.

Phone Number:

Format: 321-456-7890

Required field.

Address of property:

Required field.

Is this property?

Occupied by the owner

Rental property

Main Structure Year Built (if known):

Addition Year Built (if any):

Style of Home (select all that apply):

Wood Frame

Brick

Pine Log

Cedar Log

Modular

Manufactured

VIN # of Manufactured Home:

Other

Home Style Other (description):

Central A/C:

Yes

Heating (select all that apply):

Forced Hot Air-Gas or Electric

Heat Pump

Geo-Thermal

Other

Heating Other (description):

Basement Size:

Full

1/4

1/2

3/4

None

Basement Finish:

No Finish

Fully Finished

Partially Finished

Basement Finished % or Sq Ft:

Attic Finish:

No Finish

Fully Finished

Loft

Partially Finished

Attic Finished % or Sq Ft:

Foundation (select all that apply):

Piers

Wood

Stone

Brick

Concrete

Other

Foundation Other (description):

Exterior Walls (select all that apply):

Vinyl

Steel

Wood

Aluminum

Brick

Composite

Stucco

Other

Exterior Walls Other (description):

Roof (select all that apply):

Asphalt

Steel

Tile

Other

Roof Other (description):

Interior Finish (select all that apply):

Drywall

Log

Plaster

Panel

Enameled Steel

Other

Interior Finish Other (description):

Flooring (select all that apply):

Carpet

Tile

Softwood

Hardwood

Vinyl

Other

Flooring Other (description):

# of Rooms:
	Rooms	Bedrooms	Bathrooms	Garage Stalls
Basement	# Basement Rooms	# Basement Bedrooms	# Basement Baths	# Basement Garage Stalls
1st Floor	# 1st Floor Rooms	# 1st Floor Bedrooms	# 1st Floor Baths
2nd Floor	# 2nd Floor Rooms	# 2nd Floor Bedrooms	# 2nd Floor Baths
3rd+ Floor	# 3rd+ Floor Rooms	# 3rd+ Floor Bedrooms	# 3rd+ Floor Baths

Bathrooms: (Check all the apply)
	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Basement Bathrooms:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Bathroom #1:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Bathroom #2:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Bathroom #3:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Bathroom #4:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink
Bathroom #5:	N/A	Regular Bathtub	Whirlpool Bathtub	Shower	Toilet	Sink	2nd Sink

Is there a wet bar?

Yes

Is there a laundry room sink?

Yes

# of Fireplaces:

Freestanding

Masonry

Masonry with Gas Insert

Gas/Electric-Side Venting

Gas/Vertical Venting

Double Sided Fireplace

Wood Stove

Fireplace Other (count)

Fireplace Other (description):

Is there an Attached Garage?

Yes

Attached Garage year built:

Is there a Detached Garage?

Yes

Detached Garage year built:

Have you remodeled in the last 10 years?

Yes

Describe what was remodeled:

Have you removed any buildings in the last 10 years?

Yes

What was removed:

Comments: