Change of Ownership/Update Form

Change to Account *

Change of Ownership

Special Bill Mailing

Update

Name *

First Name

Last Name

Service Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Property *

Residential

Commercial

Tenant's Name (If Not Owner-Occupied)

First Name

Last Name

Tenant's Phone Number

(###)

###

####

Will the tenant receive a copy of the bill?

Yes

No

I request that the records of the Roslyn Water District be changed to reflect my ownership and that all future bills be sent to me at: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I am aware that the rules and regulations of the Roslyn Water District do not permit water bills to be sent to anyone but the legal owners of the premises for which the bill is rendered and that in mailing future bills as requested above, the Roslyn Water District will rely upon the truth of the contents of this form: *

First Name

Last Name

Phone *

(###)

###

####

Do you want to receive e-bills?

Yes

No

Date

MM

DD

YYYY