Required fields are marked with asterisks (*)

Pre-Authorized Payment Payment Cancellation

To cancel your Tay Township pre-authorized payment plan, please complete the form below at least 10 business days prior to the next scheduled withdrawal.

Applicant First Name

Applicant Last Name

Phone Number

Email Address

Municipal Property Address

I wish to cancel Pre-authorized payments for:

Property Tax Account

Water/Wastewater Account

By signing this form,

I confirm that I understand an additional payment may be withdrawn if notice is not provided at least 10 business days prior to the next scheduled withdrawal date;

I confirm that I understand that only the accounts listed in this application will be cancelled. If additional properties require cancellation, a separate request form must be submitted for each one.

Signature of Property Owner

Clear

Notice of Collection/Use/Disclosure

Personal information contained on this form/document/application is collected pursuant to Municipal Freedom of Information and Protection of Privacy Act, and will be used for the purpose for which it was collected. Questions about this collection should be directed to the Clerk of the Township of Tay.

This authorization form will be submitted by email to taxinfo@tay.ca.