Authorization For Direct Payment Of Propery Taxes Form Page 2

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MARTIN COUNTY
201 LAKE AVENUE
FAIRMONT, MN 56031
507-238-3211
AUTHORIZATION FOR DIRECT PAYMENT OF PROPERY TAXES
(Please, include a listing of all parcels to be included in this authorization.
Use back of this sheet to write more parcel numbers, if needed.)
Property Information: (Please Print)
Taxpayer’s Name (s): _____________________________________________________
9 Digit Property ID Number __ __.__ __ __.__ __ __ __
9 Digit Property ID Number__ __.__ __ __.__ __ __ __
9 Digit Property ID Number__ __.__ __ __.__ __ __ __
9 Digit Property ID Number__ __.__ __ __.__ __ __ __
Taxpayer’s | ________________________________________________________
Mailing
| ________________________________________________________
Address
| City: ______________________ State_______ Zip________________
Daytime Phone Number:_______________________
Home Phone Number:_________________________
Email Address ( optional ):____________________________________
The account information is as follows:
Names (s) on Account:_____________________________________________
Financial Institution Name: ___________________________________________
Type of Account, please check one: Checking__________Include a voided check
Or Savings_____________ Include a deposit slip
Bank Routing Number____________________ Account#___________________
**The voided check or deposit slip will verify the routing and account numbers.
Check if business account:
I hereby authorize Martin County to debit my (our) account for payment of real estate taxes for the
parcel described above.
Semi-annual deduction of payments: May 15 & Oct 15 and/or Nov 15
This authorization is to remain in effect until Martin County has received written notification to
terminate this authorization, or Martin County requires termination and notifies me.
Signature: _____________________________________ Date______________
Signature: _____________________________________Date_______________
Res____ AG______

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