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.. CLAY COUNTY, MINNESOTA (Clay County)

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BROWSE CLAY COUNTY (MN) FORMS

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CLAY COUNTY, MINNESOTA
Authorization for Direct Debit Payment of Property Taxes
Please fill out a separate authorization form for each property you wish to enroll
Property ID Number
□□.□□□.□□□□
PLEASE PRINT:
Property Address:
Unit #
Taxpayer's
Information:
First Name Last Name
Daytime phone number E-mail address
Mailing Street
Address:
Unit #
City State Zip
Name of Financial Institution
Account Type (Check One):
□ CHECKING □ SAVINGS
□□□□□□□□□
The se
ries of numbers printed at the bottom of a check are
the routing/transit numbers, the account number and check
number – but
are not always printed in that order.
Please note: If you choose to have withdrawal from your
savings account, you must obtain the appropriate
routing/transit information from your financial institution.
The routing/transit information on your savings deposit or
withdrawal slips is not accurate for direct debit purposes.
Routing/Transit Number (Must be 9 digits)
□□□□□□□□□□□□□□□□□
Account Number (up to 17 digits)
I hereby authorize Clay County to debit my (our) account for payment of real estate taxes for property
described above. This authority is to remain in effect until Clay County has received written notification
to terminate this authorization or Clay County requires termination and notifies me.
Signature Date
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Important Note: After completing and printing the form, make sure you CLEAR the form by clicking the "CLEAR FORM" button. If you do not CLEAR the form, your information will
be disclosed to those persons subsequently using the computer.
CLEAR FORM
Direct Debit Agreement
Confirmation of your enrollment in the program will be a property tax statement. The statement will indicate that you
are participating in the Direct Debit program and the payment stubs will show the amount and date on which your
bank account will be debited. Your payments will normally be withdrawn from your account on May 15 and October
15, however, should these dates fall on a weekend, the payment will be debited from your account within the next
three business days. Your bank statement will be your record of payment.
Your participation in the Direct Debit program will remain in effect until Clay County receives your written
request to terminate the direct payment status. Please notify our office at least three weeks prior to tax installment
due date to avoid having the payment debited. Notification of termination should be mailed to: Clay County Auditor-Treasurer,
PO Box 280, Moorhead, MN 56561-0280.
Clay County rese
rves the right to terminate the direct payment status if the parcel reflects a property
combination or division, tax adjustment, tax court petition in process, or if any attempt to debit your account is
rejected by your financial institution. You will be notified of any termination of the program by mail along with a
Property Tax Statement that will reflect any balances due and owing for the year.
Mail your completed form to:
Clay County Auditor-Treasurer
PO Box 280
Moorhead
, MN 56561-0280
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.. CLAY COUNTY, MINNESOTA (Clay County)

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Completed 17 July 2020

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