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Utility Account Move Out

Saddle Hills County

Utility Account #

Customer ID

Tax Roll

Is your property Rural or in the Hamlet of Woking

Hamlet

Rural

Municipal Address

Lot

Block

Plan

Legal Land Location

Account Holder Name

Contact Name (if company)

If moving, please provide forwarding address & phone number

Address (incl. postal code)

Home Phone

Work Phone

Cell Phone

Is C.C. value to turned off at the curb?

Yes

Date moved out

What date will you be available to confirm shutoff?

What time will you be available to confirm shutoff?

Apply deposit to account?

Yes

Who is moving in?

Customer Statement:

- I hereby acknowledge that it is my responsibility to confirm that the water service has been shut off to my property, and should any damage occur to my property as a result of not confirming that the water service has been shut off, I shall be liable for all damages to my property.
- I hereby authorize the disconnection of this water and/or sewer service and accept all charges levied for this service up to and including date of disconnection.
- In the case of metered services, I accept responsibility for any damages to the meter and/or any charges for restoring said meter to its original condition.

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Date

Notice of Collection

Protection of Privacy - The personal information requested on this form is collected under the authority of Section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of facilitating utility account change for move-outs in Saddle Hills County. Direct any questions about this collection to: FOIP Coordinator, Saddle Hills County, RR 1, Spirit River, Alberta, Canada, T0H 3G0, 1-888-864-3760.

Please send me a pdf copy of this form

Yes