2. 

   Township of Jackson
   Office of Tax Collector

   
   95 West veterans Highway
   Jackson, NJ 08527-3420
   (732) 928-1200 X1270
   Fax (732) 928-5278

   Tax Authorization Form

4. Date:*
   Date:
6. Print Name:*
8. Address:*
10. Block
11. Lot

13. Please authorize below wether you will be paying your own taxes or if you would like us to send your tax bills and related notices directly to your lending institution for them to pay out of your escrow account. 

15. Select One:

    1. Check here if you will be paying your own taxes
    2. Check here if you will be authorizing us to send tax bills to your mortgage company/bank.
17. Name of Bank:
19. Address
20. City
22. State
23. Zip Code
24. Phone #:
26. 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.

    1. I agree.
28. Electronic Signature
29. Home Owner Phone #:
31. Municipal Use Only

    ___  Homeowner Has Tax Bill

    ___  Gave/Mailed Homeowner a Bill

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

* indicates a required field