Taxes

Fields marked with an asterisk are required and must be completed prior to clicking Pay Now.

Taxpayer Type *

Self-Insured Employer

Insurance Carrier

Municipal Firefighter Cancer Reimbursement Assessment

Amount *

$

To process a Municipal Firefighter Cancer Reimbursement Assessment payment please proceed to the azicawc site.

Customer Information

First Name *

Last Name *

Organization

Email *

Phone Number *

Address

City

State

Zip

Tax Year *

Quarter *

Leave this field blank

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