PROPERTY TAX ANNUAL CONFIRMATION FOR PREVIOUSLY APPROVED ACCOUNT

SPOUSE OF FALLEN LAW ENFORCEMENT OFFICER OR RESCUE WORKER

Name of Surviving Spouse

Name of Fallen Law Enforcement Officer or Rescue Worker

Property Address

Property Account Number

I hereby certify under oath and affirmation, subject to the penalties provided by law, that the information and responses in this application are true and correct to the best of my knowledge, information, and belief.

SIGNATURE OF SURVIVING SPOUSE

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

DATE