PREPAYMENT PLAN CANCELLATION

PARCEL INFORMATION

PARCEL NUMBER(S)

PARCEL ADDRESS(ES)

TAXPAYER INFORMATION

YOUR FULL NAME

CURRENT MAILING ADDRESS

CITY, STATE & ZIP

PHONE NUMBER

BRIEF DESCRIPTION OF REASON FOR REQUEST

IF REFUND AVAILABLE, SEND TO MAILING ADDRESS ABOVE OR CREDIT TOWARD FUTURE TAXES?

I acknowledge the following with my initials below:

If my form is submitted less than 10 days from a scheduled draft date, the plan will be voided after the draft has occurred.

Possible refunds due to sale or transfer of property may require additional proof / evidence, especially at the end of a payment cycle.

DIGITAL SIGNATURE