Town of Barre Abatement Request Form

TOWN OF BARRE ABATEMENT REQUEST FORM

General Information: Request Number ______

Name:______

Mailing Address:______

Requesting Abatement for (check one):

_ Ambulance ___Property Tax ____Sewer ___Water ___Other

Reason for Abatement: (check all that apply)

_ _ (1) No probability the levy can be collected (can only be requested by the Town) __ (2) The bill was not properly assessed _ _ (3) The person liable for the bill is deceased _ (4) Financial Hardship (A monthly itemized income and expense statement must be included. Note – this information is considered confidential and will not be shared “publicly”. Immediately following the meeting the financial data will be shredded.) ___ (5) Collection would work an injustice ___ (6) Create an undue expense for the Town (can only be requested by the Town) ___ (7) Property was lost or destroyed ___ (8) Exemption amount available for late filers after May 1 but before October 1 due to claimant’s sickness, disability or other good cause as determined by Board ___ (9) Use Change taxes upon real property sold by owner who has land in current use program. ___ (10) Use Change taxes due upon agricultural land found eligible for use value appraisal if the tax is a result of disposition occurring within 5 years of initial use value assessment. ___ (11)Taxes on a mobile home due to closure of a mobile home park

Account Information:

Owner/Patient Name: ______

Map/Lot Number (if applicable) ______-______- _____ and

Property Location: ______or

Call Number _ Date of Ambulance Service _ .

Amount being requested for Abatement $______

In your own words state why the Board should abate this bill.______

_____ .

______

Dated this __ __ day of _ , 2009_, I affirm that the contents stated herewith are known to me and the information is true.

(Property Owner/Patient Signature)X______FOR OFFICE USE ONLY

Date Received: ______/______/______

Is the request complete?______. (If no the date the application was returned to the property owner

Was there any information attached to the request _ __Yes ___No

Verify the dollar amount requested? $

Date of the Board of Abatement Meeting ______/_____/_2009_

Date the property owner/patient was notified of the meeting

STAFF COMMENTS

RECOMMENDATION

The Board of Abatement voted to ____ deny ____ approve this request citing the following reason:

______