APPENDIX: WATER AND GARBAGE SERVICE APPLICATION FORM
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