2. 
4. Please complete and submit this form to request the Homestead Exemption removal:
   If you no longer qualify for the exemption(s), if you claim residency elsewhere, or if you no longer reside at this property
6. Owner First Name:*
7. Owner Last Name:*
9. Is this property owned in Trust?*

   1. Yes
   2. No

   If yes, I certify that I am beneficiary of the trust.
10. Property Index Number (PIN):*
12. Property Address:*
13. Date moved or no longer occupied:*
15. I am no longer claiming the above described property as my primary/permanent residence. I hereby request that all property tax exemptions for the above listed parcel be removed beginning with tax year:*
16. Check the box if applicable:

    1. I wish to re-pay the credit received for tax year (please fill in the box to the right):
17. Tax Year
19. Mailing Address*
21. City*
22. State*
23. Zip Code*
25. Email Address*
26. Phone Number*
28. Additional Documentation:
30. Please check all that apply:*

    1. I do not need a confirmation email
    2. I would like a confirmation email
32. This box must be checked before the form can be submitted.*

    1. I do swear or affirm that the above facts are true and accurate.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field