Form

Required fields are marked with asterisks (*)

Utility Billing Exemption Form Application

Please fill out the form to apply for a utility billing exemption.

Please note: Utility billing exemptions are granted on a case-by-case basis. The water purveyor reserves the right to refuse any application.

For any issues or help filling out the form please contact waterservice@kincardine.ca or call 519-396-4660.

Property Owner First Name

Property Owner Last Name

Civic Address

Property Roll Number

Utility Account Customer Number

Property Owner Phone No.

Property Owner email address

Please select the reason for the exemption

Demolition

Fire

Other

If Other, please describe reason

Provide Demolition Permit No.

Provide Date Dwelling was removed from property or incident date

Personal information is collected under the authority of the Municipal Act, 2001 for the purposes of applying a utility billing exemption to a property and for telephone contact by the Municipality for other municipal purposes. Questions about the collection of the personal information may be addressed to the Clerk of the Municipality of Kincardine, 1475 Concession 5, RR#5 Kincardine, ON N2Z 2X6 Phone: 519-396-3468

Contact(s)