Snow Removal Request Snow Removal Exemption Request Date Submitted* MM slash DD slash YYYY Subject Property* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Property Owner Name* First Last Property Owner Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Reason for Request:* Residential property owners who for the totality of their circumstances, considering such factors as age, physical handicap or disability, who are unable to comply with the twenty-four (24) hour requirement may submit a request for an exemption to the Housing Official by November first (1st) of each year. The property owner shall be responsible for the cost of removing the snow and ice and the fee for such work shall be collectible in the same manner in which real estate taxes are collected. No administrative fee or penalties will be imposed provided the exemption was properly obtained. Date received by HCDD MM slash DD slash YYYY Exemption Granted Yes No Signature of Housing Official First
