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2. CONFIRMED ASSESSMENT INQUIRY FORM
3. Date of Inquiry:
   Date of Inquiry:
5. PROPERTY OWNER INFORMATION
7. First Name
8. Last Name
10. Address
    Street Name & Address of Property
12. City
13. States
    -- Select One --ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY
14. Zip Code
16. Corner Lot?
    -- Select One --YES NO
17. If YES, adjacent street:
18. Parcel ID#
19. PIN#
21. Old Tax Map#
22. Block#
23. Lot#
24. Plat Book Reference
26. CONTACT PERSON:
27. Phone Number
28. Email Address
32. TO BE COMPLETED BY CITY OF DURHAM

    Select which type of Confirmed Assessment(s) information is being provided for.

    TYPE	YES?	BAL DUE	DATE BAL GOOD TO
    [CPP] Capital Facility Fee
    [CGP] Curb, Gutter & Paving
    [SL] Sewer Lateral
    [SM] Sewer Main
    [SW] Sidewalk
    [WL] Water Lateral
    [WM] Water Main

34. NOTE:
    Please allow a minimum of one (1) business day to receive a response. Only one (1) parcel per form.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field