Tax Certification Request Form

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Tax Certification Request Form
From: Contact________________________________________________________________
Company______________________________________________________________
Street Address__________________________________________________________
City ___________________________________________State____ Zip ___________
Phone _____________________________ Fax ________________________________
Email address __________________________________________________________
Please mail the certification in enclosed self-addressed, stamped envelope.
Please fax the certification to toll free fax no _________________________
Please email the certification to ____________________________________
Date: ______________________________________________
Property Information:
Assessed Name: _________________________________________________________
Assessed Property Address: ________________________________________________
Parcel Number: __________________________________________________________
City of Harrisburg: $10.00 fee payable to “Dauphin County Treasurer”
Borough of Berrysburg: $10.00 fee payable to “Dauphin County Treasurer”
Lower Swatara Township: $10.00 fee payable to “Dauphin County Treasurer”
Borough of Millersburg: $10.00 fee payable to “Dauphin County Treasurer”
Borough of Penbrook: $10.00 fee payable to “Dauphin County Treasurer”
Susquehanna Township: $10.00 fee payable to “Dauphin County Treasurer”
Borough of Pillow: $10.00 fee payable to “Dauphin County Treasurer”
*A self-addressed, stamped envelope, toll-free fax number, or email address is required. Requests that omit
these items will not be processed.
Mail to:
Janis Creason
Fax: (717) 780-6470
Email:
Dauphin County Treasurer
Dauphin County Courthouse
101 Market Street, Room 105
Harrisburg, PA 17101

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