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---- HENNEPIN COUNTY, MINNESOTA (Hennepin County)

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V.4 direct_debit_form_20161129
HENNEPIN COUNTY, MINNESOTA
Authorization for Direct Debit Payment of Property Taxes
Please fill out a separate authorization form for each property you wish to enroll.
□□-□□□-□□-□□-□□□□
13-digit property ID number
Property address: Unit #
Taxpayer's first name: Taxpayer’s last name:
Daytime phone number: E-mail address*:
*To subscribe to direct debit payment reminder emails visit: https://public.govdelivery.com/accounts/MNHENNE/subscriber/new.
Subscribing to email reminders does not ensure you are actively enrolled in the direct debit program.
Mailing street address: Unit #
City: State: Zip:
Name of financial institution:
Account type (check one): □ Checking □ Savings
□□□□□□□□□
Routing/transit number (Must be 9 digits)
□□□□□□□□□□□□□□□□□
Account number (up to 17 digits)
I hereby authorize Hennepin County to debit the above listed account for payment of real estate taxes for property
described above. This authority is to remain in effect until Hennepin County has received written notification to
terminate this authorization or Hennepin County requires termination and notifies me. By signing this form, I
acknowledge that I have read and agree to the terms and conditions described in the “Direct Debit Agreement” section
(page 2).
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V.4 direct_debit_form_20161129
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Your payments will normally be withdrawn from your account on May 15 and October 15,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.
To ensure that a successful transaction occurs, please confirm with your financial institution
that you are using an account that allows this type of draft. Also make sure that the account
and routing number you have supplied are correct, and that you have a sufficient amount of
money available at the time of withdrawals.
Please note that if your payment is rejected, refused or returned by your financial
institution, Hennepin County is not responsible for any fees you may incur from your
financial institution. In addition, you may also be charged a fee from Hennepin County for
any returned payment. Hennepin County reserves the right to terminate enrollment upon
notification from your financial institution that the attempt to debit your account was denied.
Your participation in the Direct Debit program will remain in effect until Hennepin 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: Hennepin County Taxpayer
Services, Attn: Program Enrollment, A-600 Government Center, 300 S 6th Street,
Minneapolis, MN 55487-0060.
Hennepin County reserves 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.
PLEASE NOTE: Applications are not accepted during May 1
st
– 20
th
and October 1
st
– 20
th
.
Any enrollment form received during these two time frames will not be processed until after
the 21
st
date of that month.
Mail your completed form to:
Hennepin County Taxpayer Services
Attn: Program Enrollment
A-600 Government Center
300 S 6th Street
Minneapolis, MN 55487-0060
*Manufactured Homes and Personal Property ARE NOT eligible for this program at this time.
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---- HENNEPIN COUNTY, MINNESOTA (Hennepin County)

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Completed 24 December 2020

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