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Tax Instalment Payment Plan (TIPP) cancellation of pre-authorized debit form

Please allow two weeks for change of your banking information to be processed.

Your personal information is collected by Leduc County under the authority of section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act. It will be used for the purposes for which it is collected. Questions concerning the collection and use of this information can be directed to Leduc County’s FOIP coordinator at FOIP@leduc-county.com.

Legal land description

Roll number (found on your tax notice)

Lot

Block

Plan

Name (first, last) of property owner

Property owner email

Property owner address

City:

Province:

Postal Code:

Effective date:

Please discontinue direct debit withdrawals from my bank account and remove me from the TIPP program effective on the date entered above.

I understand that upon withdrawal from the TIPP program that all applicable taxation due dates and penalties will apply.

Type name/s (first, last)

Signature

Clear

Type name/s (first, last)

Signature

Clear

Date:

Phone number

Business phone number

Please note: the current taxes, local improvement levies plus any tax arrears must be brought to current status for eligibility in the plan.

OFFICE USE ONLY

TIPP account made INACTIVE

Yes

Date made INACTIVE:

Made INACTIVE by:

Number of months credited on account:

Amount discontinued:

Reason for withdrawal:

Additional comments:

Checked by :