Form 22-0049 "Designate Mailing Request" - City of Toronto, Ontario, Canada

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Download Form 22-0049 "Designate Mailing Request" - City of Toronto, Ontario, Canada

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Form
Designate Mailing Request
Property Owner
Current Utility Account # (first 9 digits)
Assessment Roll Number (21 digits)
Property Owner(s) Name (First, Last)
Telephone Number
Property Address (Street Number, Street Name, Suite/Unit Number, City/Town, Province, Postal Code)
Current Mailing Address (Street Number, Street Name, Suite/Unit Number, City/Town, Province, Postal Code)
Please mail my Utility Bill to:
Designate Name (First, Last)
Telephone Number
Mailing Address (Street Number, Street Name, Suite/
If this request reflects a change in designate, please
Unit Number, City/Town, Province, Postal Code)
indicate the effective date of the change (yyyy-mm-dd)
By signing this Utility Bill Designate Mailing Request, I authorize the City of Toronto to follow my expressed wishes
with regard to where and to whom my Utility Bill and notices are mailed. I further agree:
1. That I will, in all cases, remain solely responsible for a Utility Bill's payment, including any loss of discount and
other fees and charges added in relation to any collection effort.
2. That the person authorized to receive utility bills and notices is also appointed by me as my agent with respect to
making payments and granting the City access to the property for purposes relating to the provision of water,
sewer and solid waste management services.
3. That I will, at all times, provide the City with current contact information for the property's occupants.
4. That the City can cancel this Utility Bill Designate Mailing Request for any reason and at any time.
5. That if I am currently enrolled in the City's Pre-Authorized Utility Payment Program, I acknowledge my enrolment
will automatically expire when the approved Designate Mailing Request Form is entered in the City's records.
Property Owner(s) Signature
Print Name (First, Last)
Date
(yyyy-mm-dd)
Mailing Designate
You are receiving this request because the named property owner(s) wishes to have his or her Utility Bill mailed to
you and is appointing you their agent for the purpose of making payments and granting the City access to the
property for purposes relating to the provision of water, sewer and solid waste management services.
The named property owner(s) will provide the City with the following personal information: your name, mailing
address and telephone number in the section above.
If you consent to the provision of the above mentioned personal information (name, mailing address and telephone
number) the City requests that you sign below. Signing below will also signify your consent to the method of collection
of personal information outlined in this form. Please have this form returned to the City. I understand that an
administrative fee per Utility Bill will be charged for every bill sent to a designate.
Print Name (First, Last)
Signature
Date
(yyyy-mm-dd)
PRINT
CLEAR
22-0049 2016-11
Page 1 of 2
Form
Designate Mailing Request
Property Owner
Current Utility Account # (first 9 digits)
Assessment Roll Number (21 digits)
Property Owner(s) Name (First, Last)
Telephone Number
Property Address (Street Number, Street Name, Suite/Unit Number, City/Town, Province, Postal Code)
Current Mailing Address (Street Number, Street Name, Suite/Unit Number, City/Town, Province, Postal Code)
Please mail my Utility Bill to:
Designate Name (First, Last)
Telephone Number
Mailing Address (Street Number, Street Name, Suite/
If this request reflects a change in designate, please
Unit Number, City/Town, Province, Postal Code)
indicate the effective date of the change (yyyy-mm-dd)
By signing this Utility Bill Designate Mailing Request, I authorize the City of Toronto to follow my expressed wishes
with regard to where and to whom my Utility Bill and notices are mailed. I further agree:
1. That I will, in all cases, remain solely responsible for a Utility Bill's payment, including any loss of discount and
other fees and charges added in relation to any collection effort.
2. That the person authorized to receive utility bills and notices is also appointed by me as my agent with respect to
making payments and granting the City access to the property for purposes relating to the provision of water,
sewer and solid waste management services.
3. That I will, at all times, provide the City with current contact information for the property's occupants.
4. That the City can cancel this Utility Bill Designate Mailing Request for any reason and at any time.
5. That if I am currently enrolled in the City's Pre-Authorized Utility Payment Program, I acknowledge my enrolment
will automatically expire when the approved Designate Mailing Request Form is entered in the City's records.
Property Owner(s) Signature
Print Name (First, Last)
Date
(yyyy-mm-dd)
Mailing Designate
You are receiving this request because the named property owner(s) wishes to have his or her Utility Bill mailed to
you and is appointing you their agent for the purpose of making payments and granting the City access to the
property for purposes relating to the provision of water, sewer and solid waste management services.
The named property owner(s) will provide the City with the following personal information: your name, mailing
address and telephone number in the section above.
If you consent to the provision of the above mentioned personal information (name, mailing address and telephone
number) the City requests that you sign below. Signing below will also signify your consent to the method of collection
of personal information outlined in this form. Please have this form returned to the City. I understand that an
administrative fee per Utility Bill will be charged for every bill sent to a designate.
Print Name (First, Last)
Signature
Date
(yyyy-mm-dd)
PRINT
CLEAR
22-0049 2016-11
Page 1 of 2
Form
Designate Mailing Request
Program Information
The City of Toronto sends one convenient Utility Bill that includes your water charges and solid waste management
fees.
The City provides property owners with the opportunity to have their Utility Bill mailed to a designate, for example a
tenant, son or daughter, lawyer or accountant. To do this, the property owner must agree to the terms and conditions
in the Municipal Code, Chapter 849, Water and Sewage Services and Utility Bill, section 849-27D. An administrative
fee will be applied to each Utility Bill mailed to a designate. Property owners will receive a copy of the Utility Bill. The
City also reserves the right to cancel this Utility Bill Designate Mailing Request for any reason and at any time.
Administrative fees are listed on our
website.
Important Information
As of July 1, 2008, the City of Toronto Municipal Code, Chapter 849, Water and Sewage Services and Utility Bill
authorizes the following:
Property owners remain responsible for the full payment of all water and sewer charges and solid waste fees if
a designate is receiving the Utility Bill.
Failure to pay a utility bill by the due date will result in the loss of the water discount and possibly other late
payment charges and fees associated with collection efforts.
Property owners are responsible for keeping the City informed of any changes to a designate (i.e. new
tenant). A new Utility Bill Designate Mailing Request form must be completed when a designate changes.
The person designated to receive utility bills and notices is also appointed by the property owners as his/her
agent with respect to making payments and granting the City access to the property for purposes relating to
the provision of water and sewer and solid waste management services.
If a Utility Bill is not paid on time, the City of Toronto reserves the right to transfer the unpaid balance to the
property owner's property tax account for collection, including any fees related to the transfer of unpaid Utility
Bill to the tax account.
If an unpaid Utility Bill is transferred to the property tax account for collection, the Utility Bill Designate Mailing
Request will be cancelled.
Submit Form
If you are interested in designating another individual to receive your Utility Bill, both property owner(s) and individual
designated to receive the bill must complete the form.
The City will only accept this form and will not accept any other forms of consent (written or otherwise) from either the
property owner(s) or the individual designated to receive the Utility Bill.
A separate form must be filled out for each property.
Submit the completed form to the City by:
Mail:
Revenue Services
P.O. Box 4500, Station A
Toronto, ON M5W 4J1
Fax:
416-696-4231*
*For tips on faxing visit toronto.ca/revenueservices
At all Inquiry/Cashier Counters at City Hall and Civic Centres
In Person:
or contact 311 - Tax & Utility Inquiry Line to speak to a customer
For further information visit
toronto.ca/utilitybill
service representative. Call 311 within city limits, outside city limits call 416-392-CITY(2489), TTY 416-392-0719.
Personal information on this form is collected under the authority of City of Toronto Act, S.O. 2006, Chapter 11,
Schedule A, s.136 (c), 261 and 264, Ontario Regulation 594/06 (Fees and Charges-Priority Lien Status) and the City
of Toronto Municipal Code, Chapter 849 (Water and Sewage Services and Utility Bill). The information will be used
for proper administration of charging of fees and charges that are imposed by the City for the supply of water and
use of a waste management system, which will include but is not limited to the updating the mailing information
concerning the utility bill account for the affected properties, mailing required bills and notices and collection of
unpaid amounts. The information will also be used for purposes of identifying agents of owners for purposes of
granting the City access to the property for purposes relating to the provision of water and sewer services.
Questions about this collection can be directed to the Manager, Customer Service, Revenue Services, 5100 Yonge
St, Toronto ON M2N 5V7 or by phone at 416-395-1048.
22-0049 2016-11
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