Fillable Volunteer Firefighter Exemption Application

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Volunteer Firefighter Exemption Application

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U.S.A. forms for City of Alvin, Texas

BROWSE CITY OF ALVIN, TEXAS (TX) FORMS

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City of Alvin
Application for Volunteer Firefighter Exemption for EMS Fees
GENERAL INSTRUCTIONS: This application is for use in claiming an exemption from the City of
Alvin EMS fee for account holders who are active volunteer firefighters. A qualified account holder
is entitled to an exemption of one property the account holder designates. This application applies
to address of the account holder from the date of the application.
FILING INSTRUCTIONS: Each account holder must furnish all information and documentation
required by this application to determine whether the qualifications for the EMS fee exemption
have been met. This document and all supporting documentation must be filed with the City of
Alvin Utility Billing office’ located at 216 W. Sealy Street, Alvin, Texas, 77511. Do not file this
document with the County, or any other agency as it only relates to the City of Alvin Emergency
Medical Services department.
APPLICATION REQUIREMENTS: The completed application and supporting documents must
be submitted to the City of Alvin and is effective from the date of submittal. An application must
be submitted by the account holder who is an active volunteer firefighter. A qualified account
holder is entitled to the EMS fee waiver of one property the account holder applicant owns or
resides at. The exemption will apply to all members who have verification that they reside at the
address. The application is effective the day is it submitted and cannot be retroactively backdated.
For mailed in, emailed, and faxed applications, the date sent or submitted shall be used as the
application date. If that day is on a holiday, or a non-City business day, then the date used for the
application will be the next business day. The application must be furnished with all information
and documentation required so the City staff can determine whether the exemption requirements
have been met. This information must be submitted with the application to the City of Alvin Utility
Billing Department. Exemption forms that are incomplete must be resubmitted. Missing,
incomplete or inaccurate forms will delay the processing and a new date will be used when all of
the required documentation has been received. Once this exemption is allowed, an application
does not have to be filed again unless the account holder changes or the qualifications for the
exemption change.
DUTY TO NOTIFY: The City of Alvin may require a new application to be filed to confirm current
eligibility. If the active status for a volunteer firefighter ends, the account holder must notify the
City of Alvin in writing as soon as possible. The City may retroactively adjust the waiver in the
event the account owner fails to notify the City and the change has occurred for more than 30
days.
City of Alvin
Application for Volunteer Firefighter Exemption for EMS Fees
SECTION 1: Property Owner/Applicant
Name of Account Holder ______________________________________________________________
Driver’s License, Personal I.D. Certificate or Social Security Number ___________________________________
Physical Address, City, State, ZIP Code ______________________________________________________________
______________________________________________________________
Phone Number (include area code) ______________________________________________________________
Email Address ______________________________________________________________
Mailing Address of Account Holder (if different): _____________________________________________________
______________________________________________________________
Section 2: Type of Exemption and Qualifications
Volunteer Firefighter’s Name (account holder) _____________________________________________________
Names of members residing at the address with the account holder:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
SECTION 3: Certification and Signature
NOTICE REGARDING PENALTIES FOR MAKING OR FILING AN APPLICATION CONTAINING A FALSE
STATEMENT: If you make a false statement on this form, you could be found guilty of a Class A
misdemeanor or a state jail felony.
I, _____________________________________________ (printed name of account holder), swear or affirm the
following:
1. that each fact contained in this application is true and correct;
2. that the account holder identified in this application meets the qualifications; and
3. that I have read and understand the Notice Regarding Penalties for Making or Filing an Application
Containing a False Statement.
_____________________________________ ________________________
Signature of Account Holder or Authorized Representative Date
Submit to: City of Alvin or Email: utilitybilling@cityofalvin.com
Utility Billing Department
216 W. Sealy Street Fax: 281-388-7215
Alvin, Texas 77511
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Volunteer Firefighter Exemption Application

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Completed 10 July 2020

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