1. Municipality/Taxing authority:
Province:
Tax year for which application is made:
2. Assessment roll number:
Name of property or custodian:
Street address or legal description:
3. Nature of frontage or area project work:
Project completion date (yyyy-mm-dd):
4. Dimensions of property - Indicate feet or metres
Frontage:
Flankage:
Total area:
a) Unit of measure used for this application
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If different from actual property dimension, explain:
b) Was the PILT amount requested determined by an engineer's report?
Yes
No
5. Determination of frontage or area levy on all abutting property
Total cost of project:
$
Total rate per unit of dimension:
$
Annual rate including interest per unit of dimension: $
Interest rate on borrowed funds %
Annual levy begins year 20 ends year 20
Total amount apportioned to federal property:
$
Less amounts paid or recoverable from other sources: $
Total PILT amount claimed:
$
Annual amount apportioned to federal property:
$
Less annual amounts paid or recoverable from other sources: $
Annual PILT amount claimed:
$
6. Does your taxing authority wish to be considered for a late payment supplement (LPS) under
the provisions of the Payments in Lieu of Taxes Act if there is an unreasonable delay in making
the payments in lieu of taxes?
Yes, only if amount exceeds $25.00
Yes, for any amount
No
If yes, provide your by-law together with a description of your taxing authority's practice for charging
interest on overdue property tax accounts, including rate of interest and compounding frequency.
Please enter the date on which interest on overdue
accounts starts to accrue on taxable property owners
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Declaration
I hereby certify that the information given in this application and in any documents attached
is true and correctly sets forth the details of the frontage or area tax and relevant special
assessments. I also certify that no other billing has been made in respect to these charges.
Signature of authorized officer
Date (yyyy-mm-dd)