T S A
E X
Comptroller of Public Accounts FORM
50-213 (8-00/2)
SAMPLE DELINQUENT TAX RECEIPT
FOR _________ DELINQUENT TAX RECEIPT FOR TAXES PAID
Collecting office name Receipt No. __________________ (Taxing units) Collecting for: __________________________________________________________________________________ Address City, State, ZIP Code ------------------------------------------------------------------------------------Property owner Property description Name _____________________________________ Address _____________________________________ City, State, ZIP Code _____________________________________ Property account number _________________________________________________________________________ Year Delinquent 1. 2. 3. 4. Date paid ___________________ Taxing Units Taxable Value Tax Rate Taxes Paid Penalty & Interest