Tax/ Utility Change Request Form

Date *

Name on File *

Civic Address *

Contact Number *

Roll Number *

Utility Account Number *

Name Change

Reason for Name Change

Current name on file

New name for File

Current Address on File

New Information

Property Purchased from:

Purchased Date

Agreement pertaining to Taxes:

Other details, if any:

Should Town Water & Sewer Billing Records be changed? Yes
No

Signature *

By clicking submit I certify that the foregoing is true and correct to the best of my knowledge and belief.

* - denotes required field