Form Center

2. Property Owner Name:*

   This must be the Owner & the Resident of the home as well as the financially responsible person.

3. Phone Number:*
4. Phone Number 2

   Please list any other phone number on the account.

6. Service Address:*

   *Do NOT need to include City, State or Zip code*

7. Email Address*
8. Special Designation*
   -- Select One --Active Duty AbatementDisabled Veteran Discount

   *Active Duty Form or Disabled Veteran Form*

10. Beginning Date*
    Beginning Date

    Beginning Date of Service or Designation of Disabled

11. Expiration Date
    Expiration Date

    Fulltime Service Expiration this is Required for Active Duty Resident

12. Attach Documentation Forms*

    Please attach the following:

    • Activation Orders showing your Name, Beginning & Ending Dates for your Service.
    • DD-214 Form &/or your letter from the Department of Veteran's Affairs establishing your Disability.
14. Electronic Signature*

    1. I Agree

    By checking 'I Agree', you agree to acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.

15. Governmental entities must obtain and process only the minimum amount of personal data reasonably necessary to efficiently achieve a specified purpose, retained for required period. Utah Code § 63A-19-401(2)(c)

16. Today's Date:*
    Today's Date:
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field