Section A - Person's Requesting Refund and Individuals name Eligible for rebate:
Your Legal Name:
User 1 Full Legal Name:
User 2 Full Legal Name:
User 3 Full Legal Name:
User 4 Full Legal Name:
Please fill out another form if more then 4 user's per house hold.
Section B - Eligible Address - Please select one below
I certify that I am a Property Owner in The Town of Bancroft
I certify that I am a Property Owner in Carlow Mayo Township
I certify that I am a Tenant or Boarder in the Town of Bancroft/Carlow Mayo Township, living at:
Roll Number:
Property Address:
Legal Description (optional):
Mailing Address for Refund:
Street Name & Number:
Town/City:
Postal Code:
Please submit supporting documents to [email protected]
Proof of Ownership or Lease
Proof of Registration
Proof of Payment
Once we receive all supporting documents your request will be sent for approval and processing.
I certify that all the persons listed in Section A live at the property described in Section B, for >6 weeks per year I Agree
Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) Statement:
The Town is subject to Ontario Municipal Freedom of Information and Protection of Privacy Act(MFIPPA) other privacy legislation. The Town will not - under any circumstances - use any information provided by visitors for any purpose that is inconsistent with the purpose for which the information was provided. Senders of messages should be aware that personal and other information contained in electronic correspondence (or printed versions thereof) which are directed to the Town are subject to Municipal Freedom of Information and Protection of Privacy Act and may be deemed releasable under this legislation, and that the anonymity or confidentiality of the sender and any information contained within the correspondence cannot be guaranteed. The Town does not collect information for commercial or marketing purposes, and the Town does not sell, exchange, or otherwise distribute the information collected through this website for commercial or marketing purposes. The Town collects and uses only the minimum information needed to meet the purpose for which the collection is required.