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PLC:

a0042e

Agency:

sargent county treasurer

For:

property tax payments

Phone:

701-724-6241 x3

Address:

355 main street south, suite 2
forman, north dakota 58032

*Required Field

Payment Information

*Property Owner Name:

Middle:

*Last:

*Parcel # 1:

*Parcel # 1 Amount:

Parcel # 2:

Parcel # 2 Amount:

Parcel # 3:

Parcel # 3 Amount:

Parcel # 4:

Parcel # 4 Amount:

Parcel # 5:

Parcel # 5 Amount:

Parcel # 6:

Parcel # 6 Amount:

Notes:

Payment Amount

*Payment Type:

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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