JOINT APPLICATION FOR PAYMENT FORM
FARM PROPERTY TAX CREDIT PROGRAM (FPTCP)
SECTION 1
TENANT
IDENTIFICATION
APPLICATION TO PARTICIPATE IN FPTCP
Name
I am requesting a farm property tax credit for the assessment
units entered in the following section.
Mailing address
Signature of the tenant
X
Municipality
Postal code
Date (day/month/year)
Department Identification Number (NIM):
SECTION 2
-
LEASED ASSESSMENT UNITS
TABLE TO COMPLETE (SEE THE REVERSE SIDE FOR THE SECTION ON HOW TO COMPLETE THE FORM)
Enter the registration number of the assessment
unit(15 digits)
Date the lease begins
Renewable lease
Date the lease ends
YES
NO
1
2
3
4
5
If there are more than five leases, please enclose a sheet containing the requested information.
SECTION 3
OWNER
IDENTIFICATION OF THE INDIVIDUAL AND/OR NAME OF THE
BUSINESS AS PER THE MUNICIPAL TAX ACCOUNT ( BLOCK LETTERS)
TERMS AND CONDITIONS OF THE PROGRAM
Name of the individual and/or business (as per the municipal tax account)
The owner of the assessment units rented to an agricultural
operation eligible for the tax credit agrees to:
Social Insurance Number (SIN) or Québec Enterprise Number (NEQ)
- receive any credit or payment for the municipal tax account of the
assessment units concerned
* You must enter one of these two numbers.
Name of the individual with the Social Insurance Number (SIN) indicated above
- receive any upward or downward adjustment on the credit amount
for the year underway for the account for the following year
Mailing address
- to return any overpayments to MAPAQ on reception of a
Department notice to that effect.
Municipality
Department Identification Number (NIM), if applicable:
Phone
Postal code
-
Name of main respondent
ACCEPTANCE OF PROGRAM (MANDATORY)
I have read and I agree to the terms and conditions of the tax credit program. I declare that the information entered here is true.
X
Signature of the owner
Name in block letters
Date (year/month/day)
CONSENT TO TRANSFER INFORMATION (OPTIONAL)
I hereby authorize the ministère de l’Agriculture, des Pêcheries et de l’Alimentation to transmit to the aforementioned tenant information about the
credits and payments for the assessment units indicated above.
X
Signature of the owner
Ministère de l’Agriculture, des Pêcheries et de l’Alimentation
Name in block letters
Date (year/month/day)
The form is available online at www.mapaq.gouv.qc.ca
2015-01
SECTION 4
MESSAGE TO THE TENANT
This joint application for payment is no longer valid if ownership changes.
You must inform MAPAQ about any changes in a lease by having your file updated. To do so, contact the Direction de l’enregistrement
des exploitations agricoles (DEEA) at toll-free 1-844-544-3332.
SECTION 5
HOW TO COMPLETE THE FORM
In order to be a tax credit program participant, you must complete this form. It is very important that you understand which information
to enter in each section. The following should help you complete the form correctly.
SECTION 1 TENANT
The tenant’s signature is mandatory in filing an application for a credit for the registered assessment units that are rented.
SECTION 2 LEASED ASSESSMENT UNITS - TABLE TO COMPLETE
Enter the registration numbers of the assessment units that you lease and the requested information about the leases in the table in this
section.
All 15 digits of the registration number must be entered. The first five digits are the municipality’s code
So that your MAPAQ credit is applied to your tax account, the lease must end after December 31 of the year for which an application for
credit is made or the year the lease becomes renewable.
SECTION 3 OWNER
This section must be completed by the owner of the units rented to you. It is very important to enter in block letters the owner’s name as
it appears in the municipal tax account, his or her address, Social Insurance Number (SIN) or Québec Enterprise Number (NEQ) and, if
applicable, Department Identification Number.
SECTION 3 ACCEPTANCE OF THE PROGRAM
The owner’s signature is mandatory in order for the credit to be applied to the units indicated in the Table in Section 2.
SECTION 3 CONSENT TO TRANSFER INFORMATION
Transfer of information to tenants about credits and payments for the assessment units indicated in the Table in Section 2 is optional.
SECTION 6
TO SEND THE FORM TO MAPAQ
Send you duly completed form to the Direction du soutien à l’enregistrement et du remboursement des taxes (DSERT).
By fax
(418) 380-2172
SECTION 7
By mail
200, chemin Sainte-Foy
1er étage
Québec (Québec) G1R 4X6
TO REACH THE DSERT CUSTOMER SERVICE CENTRE
If you have any questions about the joint application for payment form, contact the customer service centre of the Direction du soutien à
l’enregistrement et du remboursement des taxes (DSERT). To access the telephone service, make sure that you have your
Department Identification Number (NIM) handy.
Toll-free number
Phone
1 866 822-2140
418 380-2140
Ministère de l’Agriculture, des Pêcheries et de l’Alimentation
Business hours
Monday, Tuesday, Thursday and Friday:
Wednesday:
8:30 a.m. to noon and 1 p.m. to 4:30 p.m.
9:00 a.m. to noon and 1 p.m. to 4:30 p.m.
The form is available online at www.mapaq.gouv.qc.ca
2015-01