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CANCELLATION FORM

Pre-Authorized

Tax Installment Payment Plan

Please note that the cancellation must be submitted at least 10 business days prior to the next scheduled payment date.

By cancelling your monthly Tax Installment Payment Plan, you will need to pay any outstanding amounts owing before signing up again for the remainder of the year.

Today's Date:

Property Address:

Roll Number:

First Name:

Last Name:

Phone Number:

Email Address:

Please be advised that I/we wish to discontinue the monthly tax installment payments through electronic funds transfer as of:

Signature

Clear

_{This personal information is being collected for the Town of Stony Plain under the authority of Section 33c of the Freedom of Information and Protection of Privacy (FOIP) Act and will be used to collect information regarding Stop Monthly Installment Payment. The personal information provided will be protected in accordance with Part 2 of the Act. If you have any questions regarding the collection, use and disclosure of personal information, please contact the FOIP Coordinator at 780-963-2151.}