Request Form - Lien Certificate / Tax Status Report

2. FINANCE DIVISION FREDERICK COUNTY, MARYLAND Treasury Department

4. Instructions
   -Complete all of the below requested information. Property identification can be found on the Maryland State Department of Assessments & Taxation website (http://sdat.dat.maryland.gov/RealProperty/Pages/default.aspx) <br /> - Each individual parcel/property number will require its own lien certificate/tax status report and all Deeds require a lien certificate/tax status report to be accepted. <br /> - All lien certificate/tax status reports require a $20.00 fee to be paid. <br /> - For all e-recording submissions (via Simplifile), the $20.00 fee will be collected at the time of recording by Frederick County. <br /> - Submit the completed lien certificate/tax status report as a supporting document in Simplifile. <br /> - For all other submissions, the completed lien certificate/tax status report must accompany the document it supports along with a $20.00 check, payable to 'Treasurer of Frederick County'. <br /> - Please allow 2-business days for this request to be completed.

   -Complete all of the below requested information. Property identification can be found on the Maryland State Department of Assessments & Taxation website (http://sdat.dat.maryland.gov/RealProperty/Pages/default.aspx)
   - Each individual parcel/property number will require its own lien certificate/tax status report and all Deeds require a lien certificate/tax status report to be accepted.
   - All lien certificate/tax status reports require a $20.00 fee to be paid.
   - For all e-recording submissions (via Simplifile), the $20.00 fee will be collected at the time of recording by Frederick County.
   - Submit the completed lien certificate/tax status report as a supporting document in Simplifile.
   - For all other submissions, the completed lien certificate/tax status report must accompany the document it supports along with a $20.00 check, payable to 'Treasurer of Frederick County'.
   - Please allow 2-business days for this request to be completed.

6. Property Identification

8. District*

   ##

9. Account # / Parcel #*

   ######

10. District

    ##

11. Parent Acct /Parcel #

    (if applicable) ######

13. Name of Current Owner:*

15. Premise Address:*

17. City*

18. State*

19. Zip*

21. Requestor Information

23. Name of Applicant:*

25. Address*

27. City*

28. State*

29. Zip*

31. Phone Number:*

    ###-###-####

32. Choose one*

    1. Fax/E-mail (enter in field to right)
    2. Mail to Requestor

33. E-mail Address

34. Fax Number:

36. Treasury Department
    30 North Market Street Frederick, MD 21701 <br>301-600-1111 - Fax 301-600-2347 <br>TTY: Use MD Relay Services<br> E-mail: TaxStatus@FrederckCountyMD.gov https://www.frederickcountymd.gov/TaxStatus

    30 North Market Street Frederick, MD 21701
    301-600-1111 - Fax 301-600-2347
    TTY: Use MD Relay Services
    E-mail: TaxStatus@FrederckCountyMD.gov https://www.frederickcountymd.gov/TaxStatus

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field