2. Are You Filing this Application on Behalf of Another Individual*

   1. Yes
   2. No
4. Name of Submitter*
6. Year of Application*
   Year occupancy of house began by owner.
8. County*
10. Parcel Number
    (If Known)
12. Tax District
    (If Known)
14. Name of owner(s) of home*
16. Address of Home*
18. Phone Number of Applicant(s)*
20. Email
22. Date home acquired
24. Type of Home*
    -- Select One --Single family dwellingUnit within a multi-unit dwellingCondominium
26. Is the land surrounding the home more than one acre?*
    -- Select One --YesNo
28. Do you occupy all of the home as your principal place of residence?*
    -- Select One --YesNo (if no give details below)
30. Give details if no above
32. If the applicant or the applicant's spouse owns a second or vacation home, please provide the address and county below.
34. I declare under penalty of perjury that I have examined this application and, to the best of my knowledge and belief, it is true, correct and complete*

    1. Agree
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field