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2. Print off a blank Application to Discontinue Auto Payment Form if you do not wish to submit your form electronically:
   Application to Discontinue Auto Payment
4. Today Date:*
   Today Date:
5. Effective Date:*
   Effective Date:
7. Discontinue payment for: *

   1. Property Tax Auto Payment

   1. Utility Auto Payment
9. Tax Roll Number:
10. Utility Account Number:
12. Upon discontinuing auto payment, the undersinged agrees that their account will be paid in full by the due date. It is understood that in the event of late payment or non-payment, in addition to other remedies Red Deer County may have, the amount owing shall bear a penalty charge in accordance to the Municipal Government Act and the Red Deer County Bylaws. The applicant acknowledges that the failure to receive or loss of a bill cannot be accepted as a reason for non-payment. Please allow 14 days to the process the above request.
14. Name: *
15. Address:*
17. City:*
18. Postal Code:*
20. Phone Number:*
22. 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
    3) you may still be required to provide a traditional signature at a later date.*

    1. I Agree
24. Electronic Signature:*
26. Please note that the personal information requested in this form is protected under the Freedom of Information and Protection of Privacy Act (FOIP). Collection of the personal information is authorized under FOIP, Section 33(c) and is required to update previously collected personal information. If you have any questions regarding FOIP, please phone 403.350.2150 and ask for the FOIP Coordinator.
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field