Change of Ownership/Update Form Account Number 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 * (###) ### #### Email * Additional Authorized Names Do you want to receive e-bills? Yes No Date MM DD YYYY Thank you!
