Marketing Levy Registration Form

Required fields are marked with an asterisk (*)

Marketing Levy Property Registrant Form

Corporate Name:

Operating Name:

Contact Name & Title:

Telephone Number:

Fax Number:

Email Address: *

Mailing Address: *

Location of Operation (Civic Address) *

Number of Rental Units: *

Authorized Signing Officer *

I attest, on behalf of the organization, that the information provided above is accurate and complete.

Privacy Statement

In accordance with Section 485 of the Municipal Government Act (MGA), any personal information collected in this form will only be used by municipal staff and, and, if necessary, individuals under service contract with Halifax Regional Municipality, for purposes relating to the administration of By-law H-400 Respecting Marketing Levy. If you have any questions about the collection and use of this information, please contact the Access and Privacy Office at 902.943.2148 or privacy@halifax.ca.