CAP-Sewer Tenant Authorization Form

This form must be completed by the legal property owner when the tenant applying for the Customer Assistance Program (CAP-Sewer) is not the account holder on record with the Murphys Sanitary District (MSD). Completion of this authorization allows MSD to apply the CAP-Sewer credit to the qualifying tenant’s account. This authorization does not transfer ownership, billing responsibility, or account rights to the tenant.

Service Address (required)

Property Owner Name (required)

Property Owner Mailing Address (required)

Property Owner Phone # (required)

Property Owner Email (required)

Tenant Name (required)

Tenant Phone # (required)

Tenant Email (required)

Lease Start Date (required)

Lease End Date (required)

OWNER AUTHORIZATION By signing below, I, the legal property owner of the above address, acknowledge and agree to the following: 1. I authorize the tenant named above to apply for and, if approved, receive a CAP-Sewer credit on the sewer service account for the duration of their verified eligibility. 2. I understand that this authorization does not transfer billing or ownership of the account. 3. I understand that all account delinquencies or penalties remain the responsibility of the account holder of record. 4. I agree to notify MSD if the tenant vacates the property or the lease is terminated. 5. I understand this authorization remains valid only for the tenant and lease period specified above and must be renewed if the tenancy changes.

Property Owner Signature (By typing my name, I authorize MSD to process this authorization form) (required)

Date (required)

There was a problem saving your submission. Please try again later.

Please wait while your submission is being saved...

Thank you, your submission has been received.