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Internal Use Only Form Written/Owner Verified by: Date: H.T.E. Changes made by: Date: Third-Party Notification Date: Account Number: - Owner of Property: Owner’s Billing Address: Contact Phone Number: Name and Address of third-party notification: Name: Address of Service : Third Party Contact Phone Number: Owner’s Signature: Date: Please return this form to: City of Laramie Administrative Services PO Box C Laramie, WY 82073 CITY OF LARAMIE Administrative Services Department PO BOX C Laramie, Wyoming 82073 PHONE: (307) 721-5222 PHONE: (307) 721-5324 Email: [EMAIL REDACTED]