Unsecured Property Tax Penalty Waiver Request Form

Please provide the following information for your waiver request to be reviewed. All correspondence related to the decision of this request will be sent to the current address of record.

Owner Name

Owner First Name

(Owner of business or property liability)

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

Unsecured Property Tax Bill Information

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

View Sample Bill

Assessment Number

BAN (Optional)

DBA Name (Optional)

Requested Amount to be Waived

Unsecured Property Tax Penalty Waiver Request Form

Owner Name

Applicant Name

Contact Information

Unsecured Property Tax Bill Information

Waiver Request Reason