Certificate of Payment Application

Application for Certificate of Payment

Step 1 of 4

25%

{Please Check One}*
- Deed Change Only
- Sale of Property
Ordinance #2010-06 of the Village of South Holland Municipal Code establishing a Certificate of Payment requires anyone who sells property or transfers real estate to pay all outstanding service charges, including but not limited to, water service, building code violations, and other charges, due to the Village be paid in full before a Certificate of Payment Certificate is issued. This also requires the Seller to give the Village three (3) days notice before the scheduled closing to allow sufficient time to obtain a final meter reading and issue a certificate once all debts to the Village of South Holland have been paid. This procedure is also required for Quit Claim deeds. Please complete this form and either fax or deliver this form to the Customer Service Center located at 16220 Wausau Avenue.
Once this application is received, the Village will take the appropriate action to obtain a meter reading and notify the Seller of any monies due the Village. The final amount due may be paid in cash, credit card (MasterCard/Visa), cashier’s check, certified check or money order. PERSONAL CHECKS NOT ACCEPTED. Once payment is made the Village will issue a Certificate of Payment certifying that all amounts owed by the Seller have been paid in full.
Seller's Name*
First Last
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Telephone No.*
Attorney or Agent*
First Name Last Name
Attorney/Agent Telephone Number*
Property Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Property Index Number (PIN)*

To add additional PINs, click the + at the end of the row.

Water Acct Number*
Buyer's Name*
First Name Last Name
Buyer's Telephone Number*

Will the buyer occupy the residence?*
- Yes
- No
If no, please provide owners mailing address below:*
Will this be a rental property?*
- Yes
- No

Scheduled Closing Date*
Scheduled Closing Time*

: HH

MM
If you wish to be faxed the final water bill, please provide a fax number and the name to which the bill should be sent:
Fax #
Attention of:

I REQUEST A FINAL READING AT MY PROPERTY SERVICE ADDRESS. PLEASE NOTIFY ME OF ANY AND ALL AMOUNTS DUE.
Signed*
First Last
(May be signed by the seller or an authorized agent)
Date*

Application for Certificate of Payment

Step 1 of 4

I REQUEST A FINAL READING AT MY PROPERTY SERVICE ADDRESS. PLEASE NOTIFY ME OF ANY AND ALL AMOUNTS DUE.

Clerk & Collector