Under section 352(1) of the Municipal Act, 2001, c.25

Particulars of Property

Service Address:

Current Owner(s):

Roll Number:

Lot:

Plan:

Person Making Application

Applicant Name:

Contact Person:

Phone:

Fax:

Mailing Address:

Email Address:

About This Application

Reason for This Request:SaleRemortgagePurchaseOther
If Other, please State:

Person Represented:

Who is Prospective:VendorPurchaserMortgagorOther
If Other, please State:

Has this property been created from a recent severance or plan of subdivision:YesNo

Is this property in the process of being severed?:YesNo

If Sale is in Process, Give Name of Prospective Purchaser and Date of Closing

Purchaser(s):
(If company, please include contact name, position & phone number)

Date of Closing:

Applicant's Remarks:

Information about the completion of this form may be requested from the Tax Department at 705-867-2032 Ext. 203.

Please verify from your records that this certificate is for the property that you have requested, as no responsibility is accepted for a certificate other than for the property for which this certificate has been issued.

Application cost: $30

Payment Method of application fee. Payable to: Municipality of St.-Charles
CashChequeMoney Ordere-Transfer([email protected])