Request for Tax Statement

2. Tax Year*
3. Account Type*
   -- Select One --Motor Vehicle ExciseReal EstateWater Bill
5. Account/Plate Number
   -- Select One --Water Account NumberVehicle Plate Number
6. Enter Number
8. Name
9. Email Address
11. City
12. State
13. Zip Code
15. Address*

    Property Address

17. City
18. State
19. Zip Code
21. Phone Number
22. Fax Number
24. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field