For your convenience, Autofill will keep all your input data for 24 hours if you must leave the form before completing. You must use the same browser in order to pick up the form where you left off!
NOTE: You MUST click the PRINT button on the “Submit and Pay” tab to provide a hardcopy of this form. You must do this before clicking the SUBMIT button since you may not be able to print out a copy of the form for your records once you click the SUBMIT button.
If you are paying by check or money order, ensure that you have checked your choice above, then click on Print Form button below to print your form. Send with check or money order in the correct amount to: