<p> TOWN OF BARRE ABATEMENT REQUEST FORM</p><p>General Information: Request Number ______</p><p>Name:______</p><p>Mailing Address:______</p><p>Requesting Abatement for (check one): </p><p>_ Ambulance ___Property Tax ____Sewer ___Water ___Other</p><p>Reason for Abatement: (check all that apply)</p><p>_ _ (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</p><p>Account Information:</p><p>Owner/Patient Name: ______</p><p>Map/Lot Number (if applicable) ______-______- _____ and </p><p>Property Location: ______or</p><p>Call Number _ Date of Ambulance Service _ .</p><p>Amount being requested for Abatement $______</p><p>In your own words state why the Board should abate this bill.______</p><p>_____ .</p><p>______</p><p>______</p><p>Dated this __ __ day of _ , 2009_, I affirm that the contents stated herewith are known to me and the information is true.</p><p>(Property Owner/Patient Signature)X______FOR OFFICE USE ONLY</p><p>Date Received: ______/______/______</p><p>Is the request complete?______. (If no the date the application was returned to the property owner</p><p>Was there any information attached to the request _ __Yes ___No</p><p>Verify the dollar amount requested? $ </p><p>Date of the Board of Abatement Meeting ______/_____/_2009_</p><p>Date the property owner/patient was notified of the meeting </p><p>STAFF COMMENTS</p><p>RECOMMENDATION</p><p>The Board of Abatement voted to ____ deny ____ approve this request citing the following reason:</p><p>______</p><p>______</p>