Monthly: Start Date: ______

Installment: Amount $: ______

Pre-Authorized Payment Plan Authorization Form

Name: ______Roll Number: 1820-______

Address: ______

City: ______Postal Code: ______

I / We herby authorize my / our financial institution:

Name of Financial Institution: ______

Branch Address: ______

City: ______Postal Code: ______

Account Number: ______

To debit my / our account indicated above for all estimated property taxes payable for Municipal, Regional and Educational purposes to the Township of Scugog.

Please Note:

1)  For verification purposes, please enclose one of your personal cheques marked ‘VOID’.

2)  For a joint bank account, all depositors must sign if more than one signature is required on cheques issued against the account.

3)  Withdrawals are made on the last business day of each month.

4)  The tax office must be notified by the 21st day of the month in order to enroll or cancel any Pre-Authorized Payment Plans.

5)  All property taxes must be current with no arrears prior to enrollment.

Signature: ______Date: ______

Signature: ______Phone Number: ______

Pre-Authorized Payment Plan – General Information

How do I Enroll?

·  Complete and sign the Pre-Authorized Payment Plan Form.

·  Attach a blank personalized cheque marked ‘VOID’.

·  Ensure your property taxes are current with no arrears.

·  For a joint bank account, all depositors must sign if more than one signature is required on cheques issued against the bank account.

·  Submit Pre-Authorized Payment Plan at the tax office by 21st day of the month.

Monthly Payment Plan – How Much are my Payments?

·  January to June (last business day of the month) withdrawals will be based on the previous year’s annualized property taxes plus 2%.

·  July to December (last business day of the month) withdrawals will be based on the current year actual taxes less payments made to date (please note that December’s withdrawal amount may vary in order to account for the rounding of payment amounts throughout the year).

·  Notices will be sent in January and July to indicate the amount of your monthly payment. You will receive a final tax bill in June.

Installment Payment Plan – How Much are my Payments?

·  Payments will be in the amount stated on your property tax bill.

·  Payment will occur on the installment due date stated on your tax bill

·  You will receive an interim tax bill in February and a final tax bill in June.

Other Information

·  Removal from Pre-Authorized Payment Plan must be received in writing by the 21st day of the month.

·  Bank account information changes must by notified to the Township of Scugog by written notice by the 21st day of the month.

·  Defaulted payments will result in a $45.00 NSF charge applied to your tax account.

·  If three (3) payments are defaulted within a twelve (12) month period, the Township of Scugog will remove the taxpayer from the Pre-Authorized Payment Plan.

·  The Township of Scugog reserves the right to deny any taxpayer participation in the Pre-Authorized Payment Plan.

·  The final payment for the year for either plan will pull all remaining outstanding balances on the account to ensure the balance on account is zero at the end of the year.

By placing a signature on this agreement the taxpayer acknowledges that he or she has read, understood, and agreed to all of the terms of this authorization.

Signature: ______Date: ______