The board of township supervisors shall assess and levy upon each lot or parcel of land along which the sidewalk has been built by the township a sum sufficient to cover the cost of the construction thereof and shall assess and levy against each lot or parcel of land benefited by the installation of streetlights by the township. The assessment must be in substantially the following form:

The board of supervisors of the township of                                         assesses upon and levies against the several parcels of land hereinafter described the respective sums of money set against each lot or parcel. This assessment is made to defray the cost of a                             sidewalk or streetlights along the                            side of                         to                             in accordance with the resolution of the board of township supervisors passed on                         ,             , and duly published in                                     on                             ,             . The amount assessed against and levied upon each lot or parcel being the amount that it cost to construct or reconstruct the sidewalk along and fronting upon the same lot or parcel of land. When streetlights are installed the cost of the installation must be assessed and levied against all lots or parcels of land that benefit from the streetlights.

Description Name of Owner, if known                     of land             Amount Lot    Block         Dollars Cents Done at a meeting of the board of supervisors of the township of                         on                         ,            .

Attest:

Chairman    Township Clerk