CITY OF RICHMOND 2021 TAX AMNESTY PROGRAM
REAL ESTATE ELIGIBILITY APPLICATION
SE
CTION ITAX PAYER INFORMATION
[To be completed by Applicant]
First Name:
Last Name:
Business/Company Name (If Applicable):
Phone Number:
E-Mail:
Mailing Address:
City:
State:
Zip Code:
SE
CTION II REAL ESTATE TAX AMNESTY CALCULATION
[To be completed by the Department of Finance]
Parcel
ID
Tax
Year
Total
Amount
Tax Amount
Due
Collection
Fees Due
P&I
Accrued
^TAX/COL
^TAX DUE
^FEES DUE
^P&I AMNESTY
CITY OF RICHMOND 2021 TAX AMNESTY PROGRAM
REAL ESTATE ELIGIBILITY APPLICATION
SECT
ION III TAX PAYER ACKNOWLEDGEMENT AND AGREEMENT
[To be completed by Applicant]
By signing below, I certify that I am not the subject of an investigation or prosecution by any federal, state or local
government for filing a fraudulent return or failure to report on any taxes. Furthermore, I understand that any person,
individual, corporation, estate, trust, or partnership for which civil action has been filed in a court of competent
jurisdiction to enforce or collect a delinquent tax before the end of eligibility period that does not pay the full amount
of delinquent tax, attorney's fees and any other applicable charges owed on or before the last day of the tax amnesty
period (March 31, 2021) may be determined ineligible for future amnesty as well as account returned to collections
attorney/agency to continue normal collection efforts. Furthermore, I understand that Case & Sale Expenses and Fees
associated with the Delinquent Property Tax Sale Program will not be waived by my application to the Tax Amnesty
Program and agree to pay associated fees if applicable.
By signing below, I (check which applies):
Agree to a payment plan of no more than 6 months (available only if tax amount due is $500.00 or more)
Agree to pay in full taxes and fees due on or before March 31, 2021
Name:
Date:
Signature:
SECT
ION IVDEPARTMENT OF FINANCE APPROVAL
[To be completed by the Department of Finance]
Signature:
Date:
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