Maricopa

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Official Website

Fee Waiver Application

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Please be aware of the following:
1. All documents must be submitted to the Department before the Board of Health can consider granting a fee waiver.
2. Fee waiver applications submitted to the Department less than 3 weeks before the Board of Health meeting will be held over until the next scheduled meeting.
3. The Board of Health is scheduled to meet on the 4th Monday in January, April, July and October.

Mailing Address *

City *

State *

Zip Code *

Applicant First Name *

Applicant Last Name *

Email *

Electronic Signature Agreement*

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I agree.

Disclaimer
Information entered on this form will be retained by Maricopa Environmental Services Department and is a record as defined by Arizona law. This form will be provided without redaction in response to a public record request unless any of the information is exempt from release under Arizona law.

Created by AIPSS

Maricopa

Fee Waiver Application

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