Tenant Authorization Form

It is the property owner’s responsibility to ensure the account remains current at all times. Murphys Sanitary District must be notified of any change in tenancy. All outstanding account balances must be paid in full, and all required information must be provided in order to process this request. This authorization is to send courtesy billing correspondance to the tenant. Tenants may contact Murphys Sanitary District directly to obtain general billing information; however, the property owner remains ultimately responsible for payment of the account.

Effective Date: (required)

Account # (required)

Service Address (required)

I, the owner of the above reference property, request a copy of the billing for sewer service be e-mailed to (enter tenant email address below) (required)

As the property owner, I acknowledge by typing my name, I am responsible for the above account, and payment of all charges. I understand a lien may be placed on my property if charges are not paid in accordance with Murphys Sanitary District's Use Ordinance Article IX Management and Enforcement Code 02.09.020.

Owner Name (required)

Tenant Name (required)

Tenant Mailing Address (required)

Tenant Phone (required)

Tenant Email (required)

Lease Start Date (required)

Lease End Date (required)

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