Chester County Finance Department

313 West Market St, Suite 6902 West Chester, PA 19380

610-344-6190

Self-Identification for the 2025 Chester County Volunteer Emergency Services Tax Rebate Program

IMPORTANT
To qualify for the tax rebate program, the name on the eligibility list submitted by the volunteer agency and the name on this form must match the name on the tax record.

Name of first responder as it appears on parcel ownership

Tax Parcel ID Number (format = 0000_00000000/0000X00000000)

Phone Number

Status

Administration

Emergency Responder

Injured Volunteer

Name of agency where applicant volunteers (list all that apply)

Is applicant listed as an owner on the tax ID parcel?

Yes

Are the 2025 taxes paid on the above parcel?

Yes

Your taxes must be paid in full before submitting this form. Please exit the form now.

Attach supporting medical documentation for injury sustained while volunteering for a Chester County volunteer fire company or nonprofit emergency medical services agency

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By submitting this application, I declare, pursuant to 18 Pa.C.S.A. § 4904, that the information I provided herein is true and correct based upon my personal knowledge, information, and belief.

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First Name

Last Name

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