WATER
– SEWER BILLING NAME CHANGE REQUEST
VILLAGE OF NASHVILLE MICHIGAN
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 Rental Units _____
I agree with the date of sale listed above
I don’t agree with the date of sale listed
by the previous owner and agree that I am
above by the previous owner.
responsible for the water/sewer bill as of this date.
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 __________________________________