Fillable PENALTY REMISSION APPLICATION (Waimakariri District Council New Zealand)

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PENALTY REMISSION APPLICATION (Waimakariri District Council New Zealand)

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QS-M621-AA – Is 6 Page 1 of 1
170831094378
Penalty Remission Application
April 2019
215 High Street
Private Bag 1005
RANGIORA 7440
New Zealand
Phone: 0800 965 468
Email: office@wmk.govt.nz
waimakariri.govt.
nz
PENALTY REMISSION APPLICATION
Date: Valuation Number:
Property ID:
Property Address:
Penalty Amount $: Rating Year: Instalment No:
I wish to apply for a remission of this rate penalty charge on the basis that I have not received
a remission in the past four years, and in this case the late payment was due to:
OWNER AUTHORISATION
PLEASE NOTE – By entering your name in the box below you are giving your authority for the application to proceed.
Name:
Email Address:
Return completed form to: office@wmk.govt.nz
Office Use Only:
Good payment history: YES NO
Referred to Rates Office
for approval:
YES NO
Any prior remissions: YES NO
Within Remission
Policy:
YES NO
Remission of $ approved by: (CSO)
Form sent out by: (CSO)
PENALTY
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PENALTY REMISSION APPLICATION (Waimakariri District Council New Zealand)

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Completed 20 January 2021

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