Before completing this form, check out our Exoneration Page to see if your municipality and / or School District has their own Exoneration Request Form.

If you are being billed for Neshaminy School District, Tamaqua School District, Punxsutawney Area School District, or Palmerton School District, you must use the appropriate form listed on the Exoneration Page.

If the municipality and/or School District that you are being bill for is not available on our Exoneration Page, please complete and submit this form.

 

Taxpayer Information

Exemption Request Information

The Account Number can be found to the right of the name and address on the bill and also in a box titled Account Number.

What is the Tax Year you are applying to be placed on the list of taxpayers exempted from payment of the per capita and/or occupation tax for the year.

What is the Reason you are applying to be placed on the list of taxpayers exempted from payment of the per capita and/or occupation tax?

Please list the other account number(s).

If you moved out of the jurisdiction, please complete our Moved Out Exoneration Form.

I hereby state that the above facts are true and correct, and that I understand I may be subject to the penalties contained in the Pennsylvania Crimes Code for un-sworn falsifications to legal authorities if any of the above statements are incorrect.