Required fields are marked with asterisks (*)

Landlord/Property Owner Declaration for Property Tax Rebate for Registered Charities in Eligible Premises

Date:

Rebate Taxation Year:

Application cannot be processed without the completed Landord/Property Owner Declaration

Name of Registered Charity:

Address for which the Rebate applies:

Revenue Canada Charitable Registration #:

Length of Occupancy (from D/M/Y until D/M/Y) :

Name of Contact:

Mailing Address:

Phone number:

Fax number:

E-mail Address:

Total Annual Property Taxes Paid:

Organization's Share of Rentable Space (%):

I certify that the above information is true, correct and complete.

Name and Title of Signing Officer:

Signature of Signing Officer:

Date:

Required information the must be included with the application:

- copy of confirmation of Registration from Revenue Canada

- copy of the lease that clearly sets out the amount of property taxes required to be paid by the charitable organization

Please upload the required documents.

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Tax Rabate Program Pursuant to Regional Municipality of York By-Law No. A-0250-(b)-2001-066 and s.361 of the Municipal Act, 2001.

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