2. Tax Roll #:
4. Section A- Property Identification
   Please fill in required field below
6. Street Address of Property Owner*
8. Section B - Applicant's Personal Information
   Please fill in required fields below
10. Legally Registered Name of Primary Owner*
    Primary person on title who should receive the bills. (Note: only 1 person can be listed as primary owner)
12. Applicant's Name:
13. OR
14. Applicants Name:

    1. Same as above
16. Primary Owner's Address*
18. City/Town*
19. Province/Sate*
20. Postal Code/Zip Code*
22. Daytime Phone Number*
23. Email Address*
25. Section C - Applicant's Bank Account Information
    Canadian Banks Only
27. Banking Information*
    Upload a copy of a void cheque.
29. Ensure to provide a copy of a 'void' cheque (handwritten bank account information will not be accepted)
    Important: It is the responsibility of the account holder(s) to confirm that payments are being withdrawn from their bank account.
31. Section E- Authorization

    1. I have read and acknowledge that the information on the first page of this document is complete and correct.
    2. I authorize the MD of Bighorn and the above-noted financial institution to debit the referenced account beginning on the date and in the amount noted above and on the last business day of each month.
    3. Until tax levies are known, the monthly TIPP installment amount is calculated by dividing the previous year's tax levy, including local improvements by 12.
    4. If there were no taxes levied the previous year, then installments are calculated by estimating the current year's taxes, based on the purchase price divided by 12. These amounts are revised January.
    5. Monthly TIPP payments will be adjusted when all property tax levies for the tax account are known so that the total outstanding property tax levies are paid in full by the end of the calendar year.
    6. Written notification must be provided at least 5 business days prior to the next scheduled withdrawal to either change banking information or cancel plan for any reason.
    7. TIPP is non transferrable. If you are moving within the MD, you must complete a new TIPP application form for your new property.
    8. This plan is for property owners who wish to pay property taxes directly to the MD of Bighorn and not through their mortgage company. The MD of Bighorn does not charge for this service.
    9. To qualify for the TIPP, both tax and utility accounts for this property must be paid up to date.
    10. Utility arrears may be transferred to the property tax account. This would result in the monthly installment amount being adjusted upwards to compensate for the increase to the tax balance.
    11. No penalties will be levied against outstanding balances if no default in payment occurs.
    12. Should TIPP installment payment default, the MD of Bighorn reserves the right to apply service charges to the tax account, impose penalties or remove the taxpayer from TIPP.
    13. If the TIPP is cancelled or removed from the property tax account, penalties will be applied on all unpaid taxes.
    14. The plan automatically renews each calendar year unless cancelled by written notification.

    By my signature below I acknowledge that I have read and understood the following:
33. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature*
36. Date*
    Date
38. For Office Use Only
40. Lump sum payment received as calculated above.
41. Application received by:
43. Notes:
45. FOIP Notification:
    Your personal information is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act. The personal information you provide on this form is being collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act. This information will be used for the purposes of collecting utility payments. This form is deemed transitory and will be destroyed upon cancellation of PUPP account. If you have any questions about the collection or use of this information please contact the FOIP Coordinator, at the MD of Bighorn at 403-673-3611.
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

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