Secured Property Tax Penalty Waiver Request Form

Please provide the following information for your waiver request to be reviewed.

Property Information:

Block

(You may locate your block and lot by clicking here.)

Lot

Owner Name:

Owner First Name

(Name of property owner/assessee)

Owner Last Name

Applicant Name

Check if same as above

Applicant First Name

(Name of person filling out application)

Applicant Last Name

Contact Information

E-mail

E-mail Verify

Telephone Number

Mailing Line 1

Mailing Line 2

City

State

ZIP

Secured Property Tax Bill Information

Please enter information for each bill for which you are requesting a waiver. You may submit up to 4 bills per waiver application by selecting “Add Bill”. If you wish to submit more than 4 bills, you will be required to submit another request. Once complete, select “Add Waiver Reason” to continue.

View Sample Bill

Bill Type

Bill Number or Sale ID (Optional)

Requested Amount to be Waived