Notice Of Consent To Turn Off Village Water Supply
Village
of Fultonville
PO Box 337
Fultonville, NY 12072
Phone 518-853-3815
Fax 518-853-4813
Linda
Petterson-Law, Mayor Robyn
Rose, Deputy Mayor
ACCOUNT
#
Notice of Consent to TURN OFF Village Water Supply
|
THERE
IS A $30.00 CHARGE FOR THIS SERVICE
This
document serves as notice to the interested parties of the Village of
Fultonville that I/we no longer wish to be served with water from the municipal
water supply of the Village of Fultonville. Accordingly, a final meter reading
will be taken, if applicable, and a final water/sewer bill be issued of which
I/we agree to pay without penalty within 30 days of receipt of same. After 30
days a 10% penalty will be applied as prescribed by the rules and regulation
governing water/sewer usage that are currently in effect. Upon failure to pay
these charges within the current fiscal year they will be relevied to the
Village property tax bill, _______(sbl#).
Signature
Name:
Property
Location:
Billing
Address: Phone
#:
*** For Office Use Only: Work Order # ***
Date
Notice Receive: Turned
off for non-payment of rents: ___
Water
Meter Reading: Date
Read:
Disconnect
fee N/A: Paid: Billed: Bill Date:
(Disconnect
fee is not applicable to regular seasonal use only accounts)
This
certifies that water/sewer service has been shut off, with a functioning water
meter installed, as prescribed by the above notice on this date.
Date:
DPW
Superintendent
Entered
into BAS: Date By:
4/17/2018 2:13:42 PM