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WATER QUALITY PROTECTION CHARGE HARDSHIP EXEMPTION REQUEST Application for non-profit organization
Regulated by the Code of Montgomery County Regulations (COMCOR) § 19.35.01.08
Montgomery County Department of Environmental Protection

APPLICANT MUST ATTACH A COPY OF PROPERTY TAX BILL AND ALL SUPPORTING DOCUMENT TO PROCESS REQUEST AND SUBMIT NOT LATER THAN APRIL 1 OF THE YEAR BEFORE PAYMENT OF THE CHARGE IS DUE.

Property Tax Account No:* Name:*
Premise Address:*
Home Phone:* Cell Phone:
E-mail Address: Upload Documents:*
Income Verification
The request submitted by a non-profit organization must be accompanied by the organization’s most recent federal tax return or other verification of total revenues derived from the property for which the exemption is sought, as required by the Director of Finance. To qualify for a partial exemption:
  1. The amount of the Charge must exceed 0.2% of the organization’s total revenues from the property for which the exemption is sought for the year before payment of the Charge is due.
  2. The property for which the exemption is sought must be exempt from real property ad valorem taxation under State law. The amount of the partial exemption is the amount of the Charge that exceeds 0.2 percent of the non-profit’s total revenues derived from the property.
I hereby certify that the information contained in this request and the supporting documents is true and correct. I am the owner of the above identified property. I also understand that, if approved, this exemption will apply to my account only for the current tax year.

By signing this application, I hereby certify that the information contained in this request and the supporting documents is true and correct. I am the owner of the above identified property. I also understand that, if approved, this exemption will apply to my account only for the current tax year.

By checking this check box, I *sign this application.
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