Form - Water Lien Exemption Request For Notice Of Delinquent Bill Owner's Change Of Account
DES MOINES WATER WORKS
2201 George Flagg Parkway
Des Moines, IA 50321-1174
(515) 283-8700 phone
(515) 283-8768 fax
www.dmww.com
| Please select Yes or No for all three selections. |
| The undersigned represents that he or she is the landlord of the separately metered, residential, rental property identified below, and that such property is occupied or is about to be occupied by the tenant identified below. The undersigned requests an exemption from the possibility of a lien for water service to such property in accordance with section 384.84(3)(d), Code of Iowa as amended July 1, 2008. DMWW must receive a new written notice within thirty business days if there is a change in occupancy and within ten business days if there is a change in ownership. |
| WATER LIEN EXEMPTION | |
| Pursuant to sections 384.84(2)(c) and 384.84(3)(c), Code of Iowa as amended, and Section 502.3.1.2 of the Des Moines Water Works Rules and Regulations, the undersigned hereby represents that he or she is the owner of record on the property identified below, and hereby requests that he or she is given notice to the mailing address indicated below of any delinquent utility charges. |
| REQUEST FOR NOTICE | |
| As the owner of the listed property or properties below, I authorize the water service to be automatically put into my name upon the request for a final billing from the then existing tenant. I understand that I will not be notified when this change takes place. If I as owner of a property listed below request a final billing, this document for that specific address will be void. I will notify Des Moines Water Works, in writing, if this document is to be permanently canceled. |
| CHANGE OF ACCOUNT | |
| LANDLORD INFORMATION: REQUIRED FOR ALL SELECTIONS |
| Landlord Name | | Phone Number | |
| Landlord Mailing Address | | Landlord Email | |
| City/State/Zip | |
| Service Address | |
| City/State/Zip | |
| TENANT INFORMATION: REQUIRED FOR WATER LIEN EXEMPTION ONLY |
| Tenant Name | | Date of Occupancy |
 |
| Second Name | | Phone Number | |