Assessment Removal Request

By filling out this request, you understand that you may be requested to sign a contract with the City of Galena accepting a completion date for your project(s). If improvements have not been met by specified date determined by the City Council, the City of Galena may collect all or some of the special assessment fees that you have requested be removed by debt collection. You may request an extension from the City Council if needed. You are hereby accepting these terms.

Please fill out separate forms for each property request.

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Full Name *

Owner

Mailing Address *

Phone Number *

Email *

Drivers License # *

Property Address *

Address of Property you wish assessed taxes to be removed

Parcel ID *

Have you paid the taxes? *YesNoPartial

If so, what date did you pay and how much?

Plan for Property *Remodel or Repair Existing StructureNew ConstructionOther

Select all that apply. Plot Plan and/or Project Plan is required for all requests.

If you chose other please describe your plan with the property.

Approximate Value to be spent on property *

Expected Start Date *

Expected End State *

Property Usage *Owner ResidenceRentalProperty FlipOther

Amount Requested to be Removed *

Please add all year of assessment and amount.

Please attach any plot plans, proof of identification, proof of ownership, or any other documents pertaining to this request *

Click or drag files to this area to upload. You can upload up to 10 files.

These documents will be used in the approval process of your request. Plot Plan or Project Plan is required for all requests.

Electronic Signature *

The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

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