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WATER – SEWER BILLING NAME CHANGE REQUEST

VILLAGE OF NASHVILLE MICHIGAN

 

Property Address: _________________________________________________________

 

 

PREVIOUS/CURRENT OWNER INFORMATION

 

Current Owners Name: _____________________________________________________

 

Mailing address: __________________________________________________________

(if different than property address please include PO Box number)

 

Phone/contact number(s): ___________________________________________________

 

Date of sale: _______________    Owner’s Signature ___________________________      

 

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NEW OWNER INFORMATION

 

New Owner: _____________________________________________________________

 

Mailing address: __________________________________________________________

(please include PO Box number)

 

Phone/contact number(s): ___________________________________________________

 

Proposed use of property:

 

Residential __        Business __        Rental Unit(s) __        How many Rental Units _____

 

I agree with the date of sale listed above                        I don’t agree with the date of sale listed

by the previous owner and agree that I am                     above by the previous owner.

responsible for the water/sewer bill as of this date.         I purchased the property on ________

                                                                                    and agree that I am responsible for the

                                                                                    water/sewer bill as of this date.

 

_________________________________________

Signature of new owner

 

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(For office use only)

 

Approval made by phone not in person ___

Person authorizing change ______________________________

Date received ________________________________________                        

Date change made ____________________________________

Received by __________________________________