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Property Tax Adjustment Form - Section 357-358
Municipality
Roll Number
Property Address
Applicant Name
Owner Name
Contact Number
Mailing Address
Email
Reason for Application (check only one box)
Reason for Application (check only one box)
Ceases to be liable for tax at rate it was taxed - 357(1)(a)
Sickness or extreme poverty - 357(1)(d.1)
Became Exempt - 357(1)(d)(I)
Mobile Unit Removed - 357(1)(e)
Razed by fire, demolition or otherwise - 357(1)(d)(i)
Gross or manifest clerical/factual error 357(1)(f)
Damaged and substantially unusable - 357(1)(d)(ii)
Repairs/Reno's preventing normal use (min 3 months) - 357(1)(g)
Details of Reason
Effective from: (MM/DD/YY to MM/DD/YY)
Applicant Signature
Clear
Date
Assessment Report: Municipality
Has this been revised since roll return? (if yes, enter the revisions below)
Has this been revised since roll return? (if yes, enter the revisions below)
Yes
No
RTC/RTQ
2005 Base-year CVA
2008 Base-year CVA
Current Phased Assessment
RTC/RTQ
2005 Base-year CVA
2008 Base-year CVA
Current Phased Assessment
RTC/RTQ
2005 Base-year CVA
2008 Base-year CVA
Current Phased Assessment
Assessor
Assessment Report
Assessment Report
No Change in Assessment
School Board
School Board
English
French
Other
S357 Required for Next Year
S357 Required for Next Year
Yes
No
Revised RTC/RTQ
Revised 2005 Base-year CVA
Revised 2008 Current Phased Assessment
Change to Current Phased Assessment
Revised RTC/RTQ
Revised 2005 Base-year CVA
Revised 2008 Current Phased Assessment
Change to Current Phased Assessment
Revised RTC/RTQ
Revised 2005 Base-year CVA
Revised 2008 Current Phased Assessment
Change to Current Phased Assessment
Reason Original Assessment was Revised
Reason for Change (Assessor Comments)
Assessor Name
Assessor Signature
Clear
Date
Recommended
Recommended
No Adjustment
Adjustment
Cancellation
Refund
Total Amount
Treasury Position
Signature
Date
Council or Assessment Review Board Decision
Council or Assessment Review Board Decision
Approved
Amended & Approved
Not Approved
Applicant Did Not Appear
Application Abandoned
Hearing Date
Reason
Appeared for Applicant
Appeared for Municipality
Signature of Council/ARB Member
Name/Title
Submit
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