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Trash Fee Abatement Form

2. Trash Fee Abatement Form

4. Owner's Name:*

5. Acct #:

7. Address*

9. City

10. State

11. Zip Code

13. Phone Number

14. Email Address*

16. I have requested the Trash Fee be abated at the above location for the following reason:*

    1. This property is currently vacant. Please provide date vacated in "Additional Information" field.
    2. I no longer own this property. Please provide date sold in "Additional Information" field.
    3. This property is served by a private hauler under private contract with this location as the contracted address. A copy of the contract is attached.
    4. This property is a multi-family building with one or more apartments that are kept permanently vacant or are now part of another apartment building.

18. Additional Information

22. If your property is served by a private hauler under private contract:

24. Copy of Contract:

    Please upload a copy of your contract with your private hauler here.

28. If your property is a multi-family dwelling building with one or more apartments that are kept permanently vacant or are now part of another apartment building:

30. Number of Apartments at this address:

31. Number of Occupied Apartments:

32. Number of Permanently Unoccupied Apartments:

33. Date(s) Apartment(s) Permanently Unoccupied:

37. Note:
    Be advised that you are responsible for informing the City of Gardner Board of Health if any of the above information changes. Failure to inform the Board of Health of any changes to the property status may lead to a fine of $150 to $300 per offense.

    Be advised that you are responsible for informing the City of Gardner Board of Health if any of the above information changes. Failure to inform the Board of Health of any changes to the property status may lead to a fine of $150 to $300 per offense.

39. Electronic Signature:*

    I attest the information given above is true and accurate to the best of my knowledge

40. Date
    Date

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field