Please complete the below tax bill survey form. marks required fields of data. Student Information Prefix: * - Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Rev.Dr.The HonorableRabbi First Name: * MI: Last Name: * Suffix: - None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and Family Student Contact Information Street Address: * Street Address Continued: City: * State: * Zip Code: * Telephone Phone Number * Phone Type: Standard voice telephoneVideophone [VP]Text-telephone device [TTD] What are these options? Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone. Entry Information May we publish your story with just your first name? Yes No Please describe how the tax bill is impacting you: CAPTCHA
