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VILLAGE OF NASHVILLE
WATER – SEWER BILLING NAME CHANGE REQUEST
Property Address: _________________________________________
PREVIOUS/CURRENT OWNER INFORMATION
Current Owners Name: ______________________________________
Mailing address: ___________________________________________
(if different than property address please include PO Box number)
Phone/contact number(s): ___________________________________
Date of sale: _________ Owner’s Signature _____________________
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NEW OWNER INFORMATION
New Owner: ______________________________________________
Mailing address: ___________________________________________
(please include PO Box number)
Phone/contact number(s): ___________________________________
Proposed use of property:
Residential __ Business __ Rental Unit(s) __ How many Units ___
I agree with the date of sale listed above by the previous owner
and agree that I am responsible for the
water/sewer bill as of this date.
_________________________________________
Signature of new owner
I don’t agree with the date of sale
listed above
by the previous owner. I purchased the property on ___________ and agree that I
am
responsible for the water/sewer bill as of this date.
_________________________________________
Signature of new owner
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(For office use only)
Approval made by phone not in person ___
Person authorizing change ______________________________
Date received ________________________________________
Date change made ____________________________________
Received by __________________________________________
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VILLAGE
OF NASHVILLE, MICHIGAN
