Accessible Customer Service Complaint Form

Information on this form is collected in accordance with the Town's Accessibility Customer Service Policy.

Requests to join the June 9, 2020 Public Question Period may be submitted up to 9:00 am on Monday, June 8, 2020.

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of providing access information to an upcoming council meeting's Public Question Period. The meeting and any participation by the registered attendant will be live streamed, recorded, published to the town's website, and will form part of the public record. Questions about this collection should be directed to the Clerk’s Office:
‍ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.

First Name *

Last Name *

Email Address *

The email you provide is where we will send the ID that you will need to enter to join the Public Question Period.

Accessibility request

We are committed to being responsive to the needs of all residents. Let us know if you need an alternative contact method or other considerations for attending virtual Public Question Periods.

Do you agree to be contacted with information about how to join a virtual Public Question Period? Your consent is necessary for our compliance with the Canadian Anti Spam Law. *

I agree to be contacted as indicated on this form.

Question for Council *

Please be concise. There is a limit of 256 characters. You may elaborate on your question and provide context verbally during the meeting.

Security Check *

The security check is used to prevent abuse of our forms.

Thank you! Your request has been received. You will receive an email with the Meeting ID once staff has had a chance to review the information you provided. Please remember to enter the Meeting ID at app.gotomeeting.com or in the desktop or mobile GoToMeeting app.

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Questions to Council close 24 hours before the next council meeting. Questions will be answered in the order received and may not be addressed until a future council meeting.

Download / Print the Pre Authorized Payment Plan Form

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Download a copy of the Customer Service Complaint Form
Town of Mono's Customer Service Issue and Complaint Policy

Freedom of Information Request Form

Under the Freedom of Information and Protection of Privacy Act/Municipal Freedom of Information and Protection of Privacy Act. Please Note: A $5.00 application fee is required for all requests.

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to freedom of information requests. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3, 519.941.3599.
‍Name of Institution request made to: *Request for *Title

Mr.

Mrs.

Ms.

Miss

Dr.First Name *Last Name *Middle NameAddress: (Street/Apt. No./P.O. Box/R.R. No.) *City/Town *Province *Postal Code *Email *Telephone Number (Day) *Telephone Number (Evening)Detailed description of requested records, personal information or personal information to be corrected. *

(If you are requesting access to or correction of your personal information, please identify the personal information bank or record containing the information, if known.) Note: If you are requesting a correction of personal information, please indicate the desired correction, and if appropriate, attach any supporting documentation. You will be notified if the correction is not made and you may require that a statement of disagreement be attached to your personal information.

Preferred method of access to records *

Your Request Has Been Received

Prior to your request being processed, a $5 fee is required. The "Pay Fee" button will take you to PayPal where the fee can either be paid through a PayPal account or with a credit or Visa Debit card.

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Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of improving the accessibility of responding to and following-up on requests for alternative formats. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3,519.941.3599.

Name *Address *Telephone No *E-mail address

Document Request

Complete this section to request a document in an alternative format.

Name of document required *

Date required

Format requiredAudioE-TextLarge PrintIf Large Print, indicate font size (point size)

Request for an American Sign Language Interpreter

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Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purposes of improving our customer service delivery or identifying areas of opportunities. Questions about this collection should be directed to the Clerk’s Office:
ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3,519.941.3599.

First Name *

Last Name *

Address *

City/Town *

Province *Postal Code *Email Address *Phone NumberPreferred method of contact *Type of Complaint *Issue or Complaint *Attach a File

You may optionally attach a file with your submission. (Note: Only image files can be accpeted - .jpg, etc.)

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Name *Applicant status *Email address *Telephone number (only a 10 digit phone number is allowed - no spaces or hypens)* Street number and name *

Physical Address

Rural residents are asked to additionally provide their physical address as shown on your property tax bill or property deed.

Lot #Concession #Nearest Major Intersection

Material to be burned (select all that apply) *Names of attending adults (list all) *Means of extinguishing fire (select all that apply)*

Notes

Fire permits are valid until 31 December of the current year. It is the permit holder's responsibility to call the municipal office at 519. 941.3599 or check the website during dry periods or any time during the months of April and May to ensure that a fire ban is not in effect.

Only click the "Submit" button once.

Thank you! Your Fire Permit application has been successfully submitted. You will receive your fire permit by email or you will be contacted if there are any questions or concerns. Please be patient as the application will need to be processed before you receive your permit.

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* Indicates a required field.

First Name *

Last Name *

Your Question (maximum of 250 characters. This counts all letters in words and spaces used) *Additional Information / Context (maximum of 250 characters. This counts all letters in words and spaces used)

You may add additional information that you would like included in the response to your question. Please do not add anymore questions here. Only use this section to help provide any clarity that may be needed for your question to be answered.

I understand that this question will form part of the public record and I agree to have my personal information provided shared in an upcoming council meeting. *

Contact (Optional)

Please fill in this section if you would like a direct response to your question once it has been addressed.

EmailDo you agree to be contacted at this email? This is necessary for our compliance with the Canadian Anti Spam Law.

I agree to be contacted at the email specified in this form.

Security Check *

The security check is used to prevent abuse of our forms.

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Security & Sensitive Information Disclaimer

While the Town of Mono takes precautions to protect the personal information you submit on this form, all of the information provided will be sent by email to the appropriate department. E-mail correspondence on the Internet may pass through public and private networks and may be accessed and viewed by other Internet users, without your knowledge or permission.

The Town of Mono is not responsible for the security or confidentiality of information that you send to us through the Internet using email communications and this form.

By submitting this form with your information, you acknowledge that you understand the associated risks.

If you do not want your information sent through email, you can alternatively signup for pre-authorized payments by printing the Pre Authorized Payment Plan Form and mailing or bringing it to the Town Hall:

347209 Mono Centre Road
Mono, ON
L9W6S3

ATTN: Tax Collector

Pre Authorized Payment Plan Form

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for the purpose of setting up pre-authorized tax and water bill payments. Questions about this collection should be directed to the Clerk’s Office: ClerksOffice@townofmono.com, 347209 Mono Centre Road, Mono ON L9W 6S3,519.941.3599.

Full Legal Name *

First Name

Middle Name (Full)

Last Name

Exact Name(s) on the Account (please list all separated by commas) *Email *

Telephone number (only a 10 digit phone number is allowed - no spaces or hyphens)* Alternative Telephone Number

Street Number and Name *

City/Town *
Province *
Postal Code *

Financial Institution Information *

Name of Financial Institution* Financial Institution's Address * City/Town of Financial Inst. * Province * Postal Code of Financial Inst. *
Account Number ?
Branch Number ? Institution Number ?

Terms of Authorization to Debit Account

The Town of Mono is authorized to debit the account provided in respect of account number:

Property Taxes Roll Number (must be in the following format: 2212-000-###-#####-0000 and include the hyphens. You only need to change the 8 # before the last 4 0's) * ?

Choose one of the following payment options:*

Payment Option A - Monthly Withdrawals (Available for Tax only)

On or about the 15^th day of each month.

Payment Option B - Billing Installment Amounts (Available for Tax & Water)

I / We want to register for the Pre Authorized Payment Plan and acknowledge that the Town is not responsible for the security or confidentiality of the information submitted through this form*

Agree

For verification, please upload an image of your banking verification or a blank cheque marked "VOID" (image file types only - e.g., .jpg, .png.): *

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Terms

Pre Notificaiton of Amounts

Fixed Amounts: The Town of Mono will provide written notice of the amount to be debited at least ten (10) calendar days before the date of each debit.

Variable Amounts: The Town of Mono will provide written notice of each amount to be debited and the date of the debit at least ten (10) calendar days before teh date of each debit.

Business Debit Plans Only: The account holder and the Town of Mono agree to waive the above pre notification requirements.

Rights of Dispute

The account holder may dispute a debit under the following conditions:

the debit was not drawn in accordance with this Authorization;
this Authorization was revoked or cancelled;
or prenotification (as set out in paragraph 2 above) was not received.

In order to be reimbursed, the account holder must complete a Declaration Form at the above indicated branch of the Bank up to and including;

90 calendar days (in the case of a Personal / Household debit) or
10 calendar days (in the case of a Business debit), after the date on which the debit in dispute was posted ot the account holder's account.

The account holder acknowledges that disputes after the above noted time limitations are matters to be resolved solely between the Town of Mono and the account holder.

Terms of Authorization to Debit the Account

Effective at the time of submission and as per the dates indicated on the Metered Water Billing or property tax notice.

The Bank is not required to verify that any debits drawn by the Town of Mono are in accordance with this Authorization or the agreement made between the account holder and the Town of Mono.

It is acknowledged that in order to remove this Authorization the account holder must provide written notice to the Town of Mono. This authorization may be cancelled at any time upon written notice by the account holder to the Town of Mono.

The account holder will notify the Town of Mono promptly in writing if there is any change in the above account information.

Any delivery of this Authorization to the Company constitutes delivery by the account holder to the Bank. It is warranted by the account holder that all persons whose consent is required to agree ton the indicated account agree.