Tax Bill Survey

Please complete the below tax bill survey form.

marks required fields of data.

Student Information

Prefix: *

First Name: *

MI:

Last Name: *

Suffix:

Student Contact Information

Street Address: *

Street Address Continued:

City: *

State: *

Zip Code: *

Telephone

Phone Number *

Phone Type:

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

Please describe how the tax bill is impacting you:

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