Required fields are marked with asterisks (*)

Debenture Request Form

Debenture options are available for drain construction invoiced by the Municipality of Lakeshore.

A financing fee will be charged to the property tax account as per the tariff of fees.
Interest rates are set according to policy and fixed for the term.
Not eligible for prepayment before maturity.
5 year debenture issued for charges over $1,500.00 and unpaid by due date.
10 year debenture issued for charges over $10,000.00

Personal information contained on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25 and will be used for the purpose of administering the Municipality of Lakeshore revenue accounts.

Please Enter Your Name

Property Address

Roll Number

Mailing Address

City / Town

Province

Postal Code

Telephone Number

Email Address

What Drain is your invoice for?

Invoice Number

What is the amount of your invoice?

Please select from the eligible debenture term

5 Year Term - Invoice charges are over $1,500.00

10 Year Term - Invoice charges are over $10,000.00

Confirmation

By checking this box and submitting this form, I confirm the following:

I consent to the collection of my personal information included on this form, for the purpose of administering the Municipality of Lakeshore's debenture process.

Note: Questions regarding the collection, use and disclosure of this personal information may be directed to:

Division Leader - Civic Affairs,
Municipality of Lakeshore, 419 Notre Dame, Belle River, ON N0R 1A0
clerk@lakeshore.ca