2005 Cost Report APPRAISAL METHODOLOGY 9-Digit Contract #
Texas Nursing Facility CERTIFICATION
NOTE: This certification page is to be completed only by providers who are required to obtain an independent
appraisal of their facility's land and improvements.
AS PREPARER OF THE ATTACHED PROPERTY APPRAISAL AND SIGNER
OF THIS APPRAISAL METHODOLOGY PAGE, I HEREBY CERTIFY THAT:
l I am certified as a "General" Real Estate Appraiser under the authority of the Texas Appraiser Licensing and
l I have read and complied with 1 TAC Section 355.306(g)(2)(B) and all rules and instructions applicable
to this cost report, which define allowable appraised property values.
l I have prepared the attached property appraisal summary in accordance with criteria used by the local taxing
authority under the Texas Property Tax Code, Section 23.01, regarding appraisal methods and procedures.
NOTE: This APPRAISAL METHODOLOGY CERTIFICATION must be signed by the Certified General Real Estate Appraiser
who prepared the attached property appraisal. Misrepresentation or falsification of any information contained in the
appraisal may be punishable by fine and/or imprisonment.
Name of Contracted Provider
Printed/Typed Name of Preparer Title of Appraiser
SIGNATURE OF APPRAISER DATE
Subscribed and sworn before me, ________________________________________, a Notary Public,
on the ______________day of ___________________________________________, ________.
NOTARY PUBLIC, STATE OF