PIN, Tax ID, Property Identification Number
Please upload your proof of disability.
enter the name and address of the facility
Select the statement that identifies the document you submitted the first time you signed up for this exemption.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I state under penalties of perjury that to the best of my knowledge, the information contained in this application is true, correct, and complete.
This field is not part of the form submission.
* indicates a required field