Deposit Refund Claim Form - Oakville


Development related security and deposit refund claim form
This form is to be used to claim a refund for development related securities or damage deposits including but not
limited to:
* Site alteration deposits
* Road cut deposits
* Park access deposits
* Site plan security
* Subdivision security
* Condominium security
* Tree protection security
Requests for refunds will be accepted until ______________. Any unclaimed deposits after this date will be
transferred to the town.
Requests MUST include satisfactory proof of payment by the claimant (cancelled cheque, credit/debit card receipt and/or receipt
issued by the town) along with this form.
Please complete in full and print clearly:
This is a request for a refund in the amount of $________________ as reimbursement for a ___________________________
paid to the Town of Oakville in reference to _________________________(file, permit or agreement reference).
Property address related to deposit
Street no.
Street name
Unit no.
Permit number
Deposit paid by
Date deposit paid
Last name
First name
Area code and telephone no.
Company name (if applicable)
Street no. and name
Apt/Unit no.
Email address
Postal/Zip code
do hereby declare the following:
* That I am ___ the person who paid the deposit, or;
___ I have the authority to collect the refund on behalf of the original depositer (attach notarized approval)
* That there has been no previous reimbursement for any deposit paid on the permit listed above,
* That there will be no further claims for this deposit,
* That in the event that a refund of the deposit is paid to me as a result of this application, I agree to indemnify and save harmless the
Town of Oakville from any and all other claims that may be made with respect to this deposit.
*That statements contained in this request form are true and made with full knowledge of all relevant matters of the circumstances
connected with this request.
* That the information included in this request and the documents filed with this request are correct.
Print Name
Office Use Only
Refund approved
Cheque requisition date
YES ____
NO ____
Personal Information on this form is collected under the authority of the Municipal Act, 2001, as amended for processing this refund claim. Questions
about the collection of personal information should be directed to the Records and Freedom of Information Officer, Clerk's department, 905-815-6053.
Requests for refund should be forwarded by mail or in person to:
Security Administrator
Town of Oakville
Financial Planning Department
1225 Trafalgar Road
Oakville, ON L6H 0H3


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