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2. Year Charged*
3. Property Key*
5. Appellant Owner/Business*
7. Mailing Address
9. Email*
10. Phone*
12. Reason for adjustment request*
14. Request for exemption or release from*

    1. Annual Disposal Fee ($157)
    2. Landfill Fee ($15)

    Select one or both

16. If you are the owner of real estate subject to the annual household disposal fee (Greenbox fee) and pay a curbside trash pickup service, please provide proof of service via a receipt of payment during the period of July 1, 2023, through June 1, 2024, and we will remove this fee from your bill. Proof of service is required annually.

17. Attach Supporting Documentation*
19. Affirmation:*

    1. Under the penalties prescribed by law, I hereby affirm to the best of my knowledge and belief that all information submitted on this form and accompanying statements is true and complete.
21. First Name*
22. Last Name*
24. Date*
    Date
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field