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2. AFFIRMATION OF NUMBER IN HOUSEHOLD
4. I, who am the owner of affirm that I or the tenants leasing the premises receive sewer services at the above address, which is primarily used as a residence and that the total number of persons who reside at the above address for at least six months out of the year. I understand that according to the City Ordinance, I must return this signed form prior to July 21, 2023 to be eligible for reduced rates during the July 2023-June 2024 fiscal year.
6. Water Account Number*
7. Request Type
   -- Select One --Sewer Affidavit
9. First Name*
10. Middle Initial
11. Last Name*
12. Suffix
14. Phone Number*
15. Type of Phone Number:*
    -- Select One --CellHomeWork
16. Email Address*
18. Service Location Address*
19. Suite or Apt#
21. How many people are in the home?*

    1. Family of 2 or less persons
    2. Family of 3 persons
    3. Family of 4 or more persons
    4. Vacant Properties
22. Attach Additional Documents
25. "Sign" your application by typing your name below:*
26. Date:*
    Date:
Leave This Blank:


28. Submit

* indicates a required field