U.S. Department of State
(PLEASE TYPE)
PID NUMBER
APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES
TYPE OF ACCOUNT
Personal
Mission
OMB Approval No. 1405-0069
Expires: 12-31-2005
Estimated burden: 1 minute*
LOCATION (City)
COUNTRY
NAME - OFFICE OR INDIVIDUAL (Last, First, MI) (For Office, please also include a contact person)
STREET ADDRESS
CITY
USE OF PREMISES
Residential
COUNTY
TELEPHONE
Official
GAS
ELECTRIC
STATE
WATER
ACCOUNT NUMBER
UTILITY COMPANY NAME
SIGNATURE & TITLE OF APPLICANT OR AUTHORIZED OFFICER
ZIP CODE
OTHER
METER NUMBER
DATE (mm-dd-yyyy)
TELEPHONE NUMBER
AREA CODE
FOR OFFICE USE ONLY
EMBASSY
CONSULATE
UN
OAS
OTHER
DS-98 (Formerly DSP-99)
12-2002
Page 1 of 2
U.S. Department of State
(PLEASE TYPE)
PID NUMBER
APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES
TYPE OF ACCOUNT
Personal
Mission
OMB Approval No. 1405-0069
Expires: 12-31-2005
Estimated burden: 1 minute*
LOCATION (City)
COUNTRY
NAME - OFFICE OR INDIVIDUAL (Last, First, MI) (For Office, please also include a contact person)
STREET ADDRESS
CITY
USE OF PREMISES
Residential
COUNTY
TELEPHONE
Official
GAS
ELECTRIC
STATE
WATER
ACCOUNT NUMBER
UTILITY COMPANY NAME
SIGNATURE & TITLE OF APPLICANT OR AUTHORIZED OFFICER
ZIP CODE
OTHER
METER NUMBER
DATE (mm-dd-yyyy)
TELEPHONE NUMBER
AREA CODE
FOR OFFICE USE ONLY
EMBASSY
CONSULATE
UN
OAS
OTHER
DS-98 (Formerly DSP-99)
12-2002
Page 1 of 2
U.S. Department of State
(PLEASE TYPE)
PID NUMBER
APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON UTILITIES
TYPE OF ACCOUNT
Personal
Mission
OMB Approval No. 1405-0069
Expires: 12-31-2005
Estimated burden: 1 minute*
LOCATION (City)
COUNTRY
NAME - OFFICE OR INDIVIDUAL (Last, First, MI) (For Office, please also include a contact person)
STREET ADDRESS
CITY
USE OF PREMISES
Residential
COUNTY
TELEPHONE
Official
GAS
ELECTRIC
ACCOUNT NUMBER
UTILITY COMPANY NAME
SIGNATURE & TITLE OF APPLICANT OR AUTHORIZED OFFICER
DATE (mm-dd-yyyy)
STATE
WATER
ZIP CODE
OTHER
METER NUMBER
TELEPHONE NUMBER
AREA CODE
FOR OFFICE USE ONLY
EMBASSY
DS-98
12-2002
CONSULATE
UN
OAS
OTHER
(Formerly DSP-99)
Page 1 of 2
Clear
* The response time is an estimated average including the time needed to look for, get, and provide the information required.
You do not have to provide the information requested if the OMB approval has expired. We would appreciate any comments on
the estimated response burdens, and recommendations for reducing them. Please send your comments to A/RPS/DIR, U.S.
Department of State, Washington, DC 20520.
DS-98
Page 2 of 2
* The response time is an estimated average including the time needed to look for, get, and provide the information required.
You do not have to provide the information requested if the OMB approval has expired. We would appreciate any comments on
the estimated response burdens, and recommendations for reducing them. Please send your comments to A/RPS/DIR, U.S.
Department of State, Washington, DC 20520.
DS-98
Page 2 of 2
* The response time is an estimated average including the time needed to look for, get, and provide the information required.
You do not have to provide the information requested if the OMB approval has expired. We would appreciate any comments on
the estimated response burdens, and recommendations for reducing them. Please send your comments to A/RPS/DIR, U.S.
Department of State, Washington, DC 20520.
DS-98
Page 2 of 2