City of Temple Terrace Customer Service

2. Applications may be submitted electronically or can be printed and dropped off in the payment box at City Hall. If you need a printed copy of the application mailed to you, email customerservice@templeterrace.com with that request or call 813.506.6420.
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip
13. Do you have a different mailing address?

    1. Yes
    2. No
15. Address
17. City
18. State
19. Zip
21. Ownership Verification
23. Property Folio Number (from current tax bill)
25. Date of Birth
    Date of Birth
26. Age
28. Is your driver's license/state ID issued by the state of Florida?

    1. Yes
    2. No (must upload a copy of the license)
30. Driver's License Number
32. Affirmation
    NOTICE: (1) Any customer who knowingly files an affidavit required by this section that contains false information shall be guilty of an offense against the City, punishable as set forth in Section 1-39, or as otherwise provided in the City Code. (2) Any person who knowingly receives the discounted rate when the qualifying person is no longer the owner and occupant of the residential unit shall be guilty of an offense against the City, punishable as set forth in Section 1-39, or as otherwise provided in the City Code.
34. I hereby make application for the Senior Citizen Discount for the Solid Waste Annual Disposal Service Charge and affirm that I do qualify for this discount. I own and occupy the Residential Unit described above and I am 65 years or older as of this application, and have read or had read to me the contents of this form.
36. Signature
38. Date
    Date
39. Phone
41. email
43. All information submitted by this form or via email becomes a public record to the extent provided by law. Under Florida law, e-mail addresses are public records.
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field