Water Use Charge Application For Abatement

MUST BE FILED WITH THE HARWICH BOARD OF WATER COMMISSIONERS NOT LATER THAN THE DUE DATE OF FIRST ACTUAL (NOT PRELIMINARY) TAX PAYMENT FOR FISCAL YEAR OF WHICH THE WATER CHARGE BECAME A PART.

If you prefer to mail us your application, please use our printable Application for Abatement (pdf).

Abatement Application

Name of Applicant*

Mailing Address*

City/Town*

State*Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonDistrict of ColumbiaWest VirginiaWisconsinWyoming

Zip/Postal Code*

Phone Number*

Mobile Phone Number

Email Address*

The above named person, aggrieved by a Water Use Charge, hereby applies for an abatement

Date of Water Use Charge*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 200220032004200520062007200820092010201120122013201420152016201720182019202020212022

Name of Person Assessed (Owner)*

Location and Description of Property*

Total Amount Assessed*

Total Amount Requested*

If request is for Water Usage, what is the requested amount?

If request is for a late fee, what is the requested amount?

If request is for another reason, what is the requested amount?

Reason For Abatement Request*

SUBSCRIBED THIS DAY UNDER PENALTIES OF PERJURY*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 200220032004200520062007200820092010201120122013201420152016201720182019202020212022

THE FILING OF THIS APPLICATON DOES NOT STAY THE COLLECTION OF THE CHARGE. IT SHOULD BE PAID AS ASSESSED. REFUND WILL FOLLOW IF ABATEMENT IS ALLOWED.

AGREE?*  I AGREE

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