Forms • Utility Termination Request

Utility Termination Request

Leave This Blank:

Account Number (if known):

Name of Property Owner(s):*

Service Address:*

Has the home been sold?*

Requested Termination Date:

Note that the termination date must be either the date of closing or the date the new homeowner occupies the home (if arrangements are made to "rent" back for a short time).

You, as the current homeowner, are responsible for payment of services up to or until ownership changes officially, even if you are not occupying the home physically.

If the home has not been sold and is going to be rented out, the utilities must remain in the property owner's name.

"The monthly charges for all city provided services shall be billed to the record owner of the property whether the property is owner occupied, or renter occupied." Highland City Municipal Code 13.30.300

Forwarding/New Mailing Address*

City:*

State:*

Zip:*

Contact Phone Number:*

Email Address:*

Number of garbage cans at the home when you moved out:*

Number of recycle cans at the home when you moved out:*

Name of New Property Owners (if known):

Additional requests/notes, if any.

I/we certify that I/we hereby are requesting the services with Highland City be terminated for the above named premises and agree to pay any and all charges incurred for said services in accordance with rates fixed by Highland City. I/we agree to pay all reasonable attorney fees and any and all other cost incurred by Highland City to obtain collection on this account should any outstanding balance remain unpaid.*

Yes I agree

No I do not agree

***If you have an account set up with Xpress Bill Pay or Bank Bill Pay through your financial institution, YOU need to log on to your account and terminate your automatic payments.
If you have Direct Pay with Highland City, please comment here so we can terminate your Direct Pay account.

INTERNAL USE

Subdivision:

Plat:

Lot:

Account #:

PI Square Footage:

PI Water Purchase?:

Open Space?:

Culinary Meter Read Date:
Culinary Meter Reading:
Culinary Water Usage:
Culinary Meter ID/EMR ID:
MXU ID:

PI Meter Read Date:
PI Meter Reading:
PI Water Usage:
PI Meter ID/EMR ID:
MXU ID:

Door Notice Date:
Application Due Date:
Lock off water:

Highland City Privacy Policy: https://highlandut.gov/DocumentCenter/View/9446/Privacy-Policy-102025

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