TOWN OF HAMILTON, INDIANA
Department of Water
Clerk-Treasurer’s Office
APPLICATION FOR WATER AND GARBAGE SERVICE
BY PROPERTY OWNER AND TENANT/PURCHASER
Application Date Account #
Service Address
Name of Resident
Renting Land Contract Buying
Property Owner Information:
Name Co-Owner
Social Security # Social Security #
Address
Telephone
Tenant/Contract Purchaser Information:
Name Co-Applicant
Social Security # Social Security #
Driver’s License # Driver’s License #
Mailing Address
(If different from service address)
Telephone
Number of People at Service Address: Adults Children
Employer Employer
Emp. Address Emp. Address
Previous Address
Previous Landlord Name and Address
By completing and signing this form, utility services will be provided to a tenant/contract purchaser; however, the ordinances of the Town of Hamilton will provide that the property owner is responsible for all water and sanitation services provided to the owner’s property, including rental properties or contract sale properties. In consideration for providing services to a tenant or contract purchaser of owner’s property, the property owner agrees:
1. To be responsible and pay for all utilities consumed on the above-mentioned premises. This section also applies to rental property and contract sale property.
2. The meter furnished by the Utility is, and shall remain, the property of the Utility, and the Utility’s agents shall have access to the meter at all times to read, to repair, to lock off, seal or remove the same.
3. The Utility’s agents shall have access to the meter, pipes, wires and conduits at all times to ascertain that the service supplied is passing through the meter and is properly registering the same, and to stop the supply of service for non-payment of bills, without notice, when past due, or for any other lawful cause or purpose which the Utility may deem sufficient. The agents and employees are hereby authorized to enter the premises of the applicant, at all times, for any such lawful cause or purpose, such as disconnecting or adjusting the meter, removing the meter, with connections, or any other property belonging to the Utility.
4. Nothing contained herein shall mean, or be construed to mean, that the Utility shall be required to inspect or examine, or in any way be responsible for the condition of the pipes, wires or conduits on the Applicant’s premises.
5. I have received a copy of the rules and regulations. (initials)
6. I, the owner, (want/do not want) to receive monthly bills for this property.
Date
Owner’s Signature
Date
Co-Owner’s Signature
Date
Tenant/Purchaser’s Signature
Date
Co-Tenant/Purchaser’s Signature
Co-Tenant/Purchaser’s Signature