Lumpkin County, GA · Lumpkin County
Delayed Payment Form
Lumpkin County Parks and Recreation participants use this form to set out a payment plan for a program balance owed to the department.
At a glance
- Issued by
- City of Lumpkin County · Lumpkin County, Lumpkin County, Georgia
- Notarization
- Not required: file this form without a notary.
- Official source
- lumpkincounty.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form records a payment plan between the Lumpkin County Parks and Recreation Department and a program participant. It asks for the program, children’s names, amounts owed, payoff dates, total owed, down payment, current balance, and payment schedule. The form states that participation privileges may be revoked if the plan is not followed, until the balance is paid in full.
Who needs it
A participant who needs to arrange delayed payment for a Lumpkin County Parks and Recreation program can use this form to record the agreed plan.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the participant, program director, and a witness sign, and the participant and witness provide dates.
How to submit this form
- 1
Download the Form
Download the Delayed Payment Form.
- 2
Complete the Form
Fill in the program, participant and child details, amounts owed, down payment, current balance, and payment schedule.
- 3
Gather Attachments
The form does not identify any required attachments.
- 4
Submit to the County
Submit it to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What does the Lumpkin County Delayed Payment Form record?
- It records a payment plan for a Parks and Recreation program, including amounts owed, a down payment, current balance, payment schedule, and payoff dates.
- Who uses this delayed payment form?
- A participant arranging delayed payment for a Lumpkin County Parks and Recreation program can use the form to record the plan with the department.
- Do I need a notary for the Delayed Payment Form?
- No. This form has signature lines for the participant, program director, and a witness, with dates for the participant and witness; it does not require notarization.
- How do I submit the Delayed Payment Form?
- Submit it to the county department named on the form; check the county website for current contact details.