Tax Sewer Abatement Form

TAX SEWER ABATEMENT FORM

Taxpayer Identification

Individual / Sole Proprietor C Corporation S Corporation Partnership Trust / Estate LLC Other

Taxpayer Identification Number (TIN)

Provide either Social Security Number (SSN) or Employer Identification Number (EIN). Do not enter both.

Property / Account Information

Assessment Details

Assessment Amount Claimed Incorrect: $   Assessment Date:

Grounds for Abatement (select applicable reasons)

Incorrect assessment amount or calculation error Property is exempt from sewer assessment by statute or ordinance Payment made in error or duplicate payment Demonstrable financial hardship or inability to pay Physical damage or change in property use affecting liability Other (explain below)

Supporting Documentation (attach with submission)

Check the documents included with this request:

Proof of payment or receipt Photographs or evidence of property condition Professional inspection or repair report Deed, exemption certificate, or legal instrument Other supporting documents (describe below)

Administrative Declarations and Authorization

By submitting this form the taxpayer certifies that the information provided is true, complete and correct to the best of their knowledge and that the taxpayer authorizes the municipal tax authority to verify any information, inspect the property records and payment history, and obtain relevant documentation from third parties as necessary to adjudicate this abatement request.

If an abatement is granted, the authority may apply any credit to outstanding municipal obligations and will issue refund or credit in accordance with municipal procedures. The taxpayer acknowledges that false statements may subject the signer to civil or criminal penalties under applicable law.

Certification Under Penalty of Perjury

The undersigned certifies, under penalty of perjury, that the following statements are true and accurate:

1. The taxpayer is the person or entity legally responsible for the sewer assessment or has been duly authorized to file this request on behalf of the taxpayer.
2. The facts stated in this application and all attached documentation are true and complete and fairly represent the circumstances giving rise to this abatement request.
3. The taxpayer understands that providing false or misleading information may result in denial of the abatement, recovery of amounts abated, assessment of interest and penalties, and referral for prosecution where appropriate.
4. The taxpayer consents to disclosure and verification of relevant records maintained by municipal departments and private third parties to the extent necessary to consider this request.

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