PAP Cancellation Request - Property Taxes

Required fields are marked with asterisks (*)

Pre-Authorized Payment Plan (PAP) Cancellation - Property Taxes

This form allows you to cancel your Pre-Authorized Payment Plan (PAP) for your Thames Centre Property Taxes.

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of Municipal Act, 2001. This information is collected and maintained for the purpose of sending out electronic mail billing. Questions or concerns about the collection of this information can be directed to the Clerk at 4305 Hamilton Road, Dorchester ON N0L 1G3, Phone: 519-268-7334 ext 254 or clerk@thamescentre.on.ca

Full Name of Account Holder

Name of Additional Account Holder

Street Number

Street Name

City/Town

Postal Code

Phone Number

All cancellation requests must be requested in writing at least 28 days prior to withdrawal date.

Cancellation Date

Reason for Cancellation

Assessment Roll Number

I/We hereby withdraw from the Pre-Authorized Property Tax Payment Plan with respect to the above noted property.

Authorized Signature

Clear

Authorized Signature (2)

Clear

Date

If more than one signature is required for withdrawls, all authorized signatures must be given.