Affidavit Requesting Removal

AFFIDAVIT REQUESTING REMOVAL

FROM GENERAL TAX LIST PER O.R.C. §319.28(B)(1)

(Print First and Last Name), being first duly sworn, says that they have personal knowledge of all of the facts contained in this affidavit and that they are competent to testify to the matters stated herein. Affiant further states as follows:

1. I am, or my spouse is, currently one of the following: peace officer, parole officer, probation officer, bailiff, prosecuting attorney, assistant prosecuting attorney, correctional employee, county or multicounty corrections officer, community-based correctional facility employee, youth services employee, firefighter, EMT, medical director or member of a cooperating physician advisory board of an emergency medical service organization, state board of pharmacy employee, BCII investigator, judge, magistrate, or a federal law enforcement officer.
2. I hereby request, pursuant to Ohio Revised Code Section 319.28(B)(1), that the Pickaway County Auditor replace my name as property owner from the general tax list of real and public utility property for the property known as:
   (Street Address, City, State, Zip code),
   Tax District/Parcel # .
3. I understand that my name, Your name as it appears on the tax list, will be replaced by my initials, as authorized by law, to Initials to replace your name, to indicate ownership of the above listed property.

Further, affiant sayeth naught.

Sworn to before me and subscribed in my presence this day of , 20.