Quarterly Tax Form

Kathy Francis

Kathy Francis

P.O. Box 315 Versailles, MO 65084

I (we) have read the installment plan information and wish to enroll in this installment plan for our real estate tax bills listed below, beginning with the next year's tax payment.

I (we) understand that there will be a total of 4 installments based on the amount that was paid for the previous year's tax due. Three installments will consist of equal installments with the fourth being the balance of the tax due.

I (we) understand that all payments are due by December 31st and that failure to pay the balance due by December 31st will result in penalties and fees being charged on the full tax amount.

Upon receipt of this signed agreement, coupons will be sent to you to begin your installment payments.

The total will be noted on your current year tax statement.