TAX ARREARS INSTALLMENT PAYMENT PLAN APPLICATION PRE-AUTHORIZED

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           TAX ARREARS INSTALLMENT PAYMENT PLAN APPLICATION & PRE-AUTHORIZED DEBIT FORM
                                  CITY OF LETHBRIDGE – ASSESSMENT & TAXATION DEPARTMENT
                                     910 – 4 Ave. South, Lethbridge, AB T1J 0P6 Phone: 320-3950

OWNER/APPLICANT NAME:
ADDRESS:                       CITY:             PROV:              POSTAL CODE:
PROPERTY ADDRESS:
__________________________________________________________________________________________________________

1.         I/We hereby apply to the City Tax Collector to pay taxes in arrears and/or current taxes by installments pursuant to the Tax
           Arrears Installment Payment Plan By-Law.

           Type of Payment:      Option A (Arrears & Current)                    Option B (Arrears Only)

2.         I/We hereby authorize a debit, by post-dated cheques, in the amount calculated below (subject to adjustments) to be drawn
           on my/our account on the same day each month beginning on the effective date of this agreement and including last
           payment date.

           Monthly Installment Calculation:                                   Effective Date of Agreement:
           Of agreement (maximum 24 months):          Months                             Date of First Payment:
                                                                              Date of Last Payment:
                                                                              Penalty Rate (under plan) per annum:    %
           Total Taxes in arrears as of effective date:                                  $
           Estimated current taxes payable during term of agreement:                     $
           Monthly payment amount: (amortization / payment schedule attached)            $

3. I /We acknowledge that by opting for Option B, that I/We will pay the current taxes prior to due date. If payment is not made I/we
     are in default on this agreement.

4. I/We acknowledge that the City Tax Collector may revise the monthly installments payable under the plan for reasons as stated in
     the Tax Arrears Installment Payment Plan By-Law, and he will provide one month advance notice of any such revision to the
     applicant.

5. I/We also acknowledge that;
     (a) at least 2 weeks written notice will be given to the City Tax Collector if I/we are going to withdraw from the plan.
     (b) Upon withdrawal, all current taxes and arrears are due and payable on the effective date of the withdrawal,
     (c) From the effective date of withdrawal the applicant is no longer entitled to any penalty discounts provided by this plan.

6. I/We also acknowledge that;
     (a)   upon default of payment of a monthly installment, the City Tax Collector may cancel the applicants participation in this plan,
     (b)   upon default more than twice during the plan, the City Tax Collector must cancel the applicant participation,
     (c)   upon cancellation the applicant shall not be entitled to any penalty discounts provided by this plan,
     (d)   upon cancellation, all current taxes and arrears are due and payable on the effective date of cancellation.

7. I/We also acknowledge any payment not honored or processed by my / our bank is subject to service charge, and that all
     dishonored payment made under this plan and service charges must be paid in full within 10 days of installment date to continue
     participation in the plan, subject to the approval of the City Tax Collector.

8. In the event I/we change my/our bank account, I/we will provide new cheques for the remainder of the agreement.

9.   All persons whose signatures are required to sign on the bank account listed above, have signed their agreement below.

10. By copy of this application, owner constitutes notification of Terms and Conditions provided by the City of Lethbridge’s Financial
    Institution.


_____________________________________                                      ______________________________________
Signature                                                                  Signature
Date:                                                               Phone:       (Res)      (Bus)


Approved: YES             NO                      CITY TAX COLLECTOR: _________________________________________