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Senior Citizen Sewer Charge Deduction Claim Form

  1. CitySeal-2020 v2

  2.                                                              CITY OF PASSAIC

  3. CLAIMS FOR SENIOR CITIZEN $122 ANNUAL SEWER CHARGE DEDUCTION

  4. Requirements

    The Claimant must be at least sixty-five (65) years old and the owner of record for the property for which the $122 deduction is claimed.

  5. Is the dwelling (check one): single family home
  6. 2 or more family dwelling
  7. Age verified by:
  8. Age Verified by:
  9. Claimant Certification

    CLAIMANT CERTIFICATION:

    I certify that the above declarations are true to the best of my knowledge and I understand that they will be considered as if made under oath and subject to penalties for perjury if falsified.

  10. FOR OFFICIAL USE
  11. Leave This Blank:

  12. This field is not part of the form submission.