APPLICATION FORM FOR MEMBERSHIP YEAR 2008
Please Type or Print Clearly:
Name of
Municipality____________________________________
County________________________________________
Please check a category type below:
___ Tax Receiver
___ Tax Collector
___ Town Clerk/Tax Collector
___ Deputy
____General Membership )Includes businesses and other interest groups)
____ Social Membership ($10.00 per year-no voting power)
Name______________________________________________________________
Office Mailing Address________________________________________________
City_________________________State_______Zip Code____________________
Telephone # ( )_______________________________________ Ext.___________
Fax# ( )________________________________
Email address_________________________________________________
Number of Years as Receiver/Collector_____________________
Receiver/Collector/Deputy Annual Dues - $25.00- After March 15th, additional $15.00
General Membership Annual Dues - $50.00
PLEASE FILL IN THE ABOVE PORTION AND RETURN WITH DUES TO:
Karen
Roach, Receiver of Taxes
Town of North Salem
270 Hilltop Drive
North Salem, NY 10560
Telephone – 845-669-8635
Email:
kroach@northsalemny.org