Caroline County Health Department, Maryland

CAROLINE COUNTY HEALTH DEPARTMENT
Division of Environmental Health (Hours 8-5p.m., M-F; Phone: 410/479-8045)
403 S 7th Street, P.O. Box 10, Denton, MD 21629

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REQUEST FOR PROPERTY STATUS REPORT

A SEPARATE REPORT IS REQUIRED FOR EACH PARCEL

Enclosed is my check for current feeof $_______ (payable to Caroline County Health Department).

Please send a property status report for property owned by________________________________

located on________________________________________ Road

Tax Assessment Map______, Grid/Block______, Parcel_______ Lot____(if applicable),

Name of Subdivision (if applicable):_________________________________.

Applicant's Day Phone Number:____________________________

Send report to: Name:___________________________________________

Mailing Address:________________________________________________

City/State/Zip:__________________________________________________

Fax report to:__________________________________(put n/a if you do not want us to fax this report)

EMAIL ADDRESS:___________________________________________________________________

I understand this report may take a minimum of 30 days processing time

Owner's Signature:______________________________________________ Date:_______________

HD USED ONLY: Date Rec’d:________________________ Receipt #________________________ PSR#________________