Property Or Account Request For Information Form - Town Of Naicam
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1REQUEST FOR INFORMATION FORM
To provide information regarding a property or account, this form, duly authorized and signed by the homeowner
must be received by our office prior to the disclosure of this information. Please fill in the form for the information
required and sign and date the form.
Requestor’s Name:___________________________________
Date Requested: ____________________________
Company/Organization: ______________________________
Date needed by: ____________________________
The following request applies to the following property and/or title:
Legal Land Description: ____ ____-____-____-W2 / OR / Lot:_____ Blk:_____ Parcel:_______________
Part Sec Twn Rge
Civic Address: ____________________________________
Title #: __________________________________________
Please provide the following information:
Assessment / Field Sheet
Taxes per year (current or prior year levy, amounts outstanding, or status of account)
Utility billing (amounts outstanding, or status of account)
Other _______________________________
If you require an official tax certificate, please indicate this below. A fee of $20 must be supplied to the Municipality
with a copy of this request prior to our office sending the tax certificate.
Tax Certificate Requested? YES
NO
PERMISSION FROM OWNER(S) and/or TENANT(s) (if applicable) GRANTED TO RELEASE INFORMATION
___________________________________________
_______________________________________________
Name (Owner)
Signature
___________________________________________
_______________________________________________
Name (Owner)
Signature
___________________________________________
_______________________________________________
Name (Tenant)
Signature
___________________________________________
_______________________________________________
Name (Tenant)
Signature
Date:_________________________
OFFICE USE ONLY
Request Received Date:________________________ Staff Initial: _______
Request Fulfilled Date: _________________________ Via: Post / E-mail / Fax Staff Initial: _______
Tax Certificate Payment Received:____________ Chq#:_____ Receipt #:___________ Staff Initial: _______
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Parent category: Business