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AUTHORIZATION TO AUTOMATICALLY WITHDRAW FUNDS TO PAY CURRENT AND FUTURE TAXES Rebecca C. McNeil - McLean County Treasurer This program provides convenient and timely payment of your Real Estate Taxes Parcel Number: Daytime Phone: Date: Financial Institution's Name: City: State: Name: Signature: I hereby authorize the McLean County Treasurer to withdraw funds according to my selection above from my checking or savings account at the financial institution named above. If funds are not available, the payment will not be made, and all penalties will apply to tax payer. Your bank statement will serve as your receipt for this transaction. This authority remains effective until I terminate this agreement in writing. I wish to: Enclose voided check or savings deposit slip for new participants/changes. This form must be received 10 days before due date printed on bill. Participate Make a Change Terminate Please use my Checking Account Savings Accoun Funds will be automatically withdrawn each tax year on the due date for each installment. ---PAGE BREAK---