BAS TAX Information Request Form

Please complete this form along with attaching two tax bills. Note: If you have not yet received your bills and warrant, please call your County representative to get this information as we cannot process your files until we receive this.

Municipality *

County *

Contact *

Title *

Email *

example@example.com

2nd Email (optional)

example@example.com

Phone Number *

Area Code Phone Number

Billing Cycle *

Total Number of Tax Bills to be Collected: *

Total Taxable Amount (minus Star) *

Total Taxable Amount (money to be collected): *

If not applicable place N/A on at least one field below *

	Period Start	Period End	Penalty %	Pay to County
Collections
Collections
Collections
Collections
Collections
Collections
Collections
Collections

Starting date for unpaid letter (2nd Notice)

Fee Amount:

INSTALLMENT PERIOD DETAILS (if applicable)

	Start Date	End Date	Penalty
Installment 1
Installment 2
Installment 3
Installment 4

AMOUNT COLLECTED FOR EACH ROLL SECTION (if applicable)

Taxable - Section 1

State-Owned Land - Section 3

Special Franchises - Section 5

Utilities - Section 6

Railroads - Section 7

Wholly Exempt - Section 8

Omitted & Proportioned - Section 9

Attach 2 Sample Tax Bills (current billing year)

Browse Files

Sample Bills *

Note: We reserve the right to charge the RPS processing fee more than once if the conversion process has to be redone due to errors at the county or town level.

Comments

BAS Tax Collection Information Request