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" APPLICATION FOR WATER, SEWER AND STORMWATER SERVICES Service Address: Customer Name: Billing Contact Person Billing Address: City, State, Zip: Home Phone Work Phone Email Address: Fax 1) Have you ever had services in your name from this utility before? YES NO 2) Do you owe any outstanding bills for this utility? YES NO 3) Have you filed bankruptcy within the past 4 years? YES NO 4) This service is Residential _______Commercial _______Industrial _______Governmental________ If Residential, this property is: Single-Family _______Multi-Unit of Units If Commercial: Are you Tax Exempt? NO ________(Please provide a copy of your Tax Exempt certificate) 5) I Own _______Manage _______Rent/Lease this property. Date Purchased (owner) : Date Occupied (tenant) : Copy of legal document MUST be submitted as Proof of Ownership. 6) If Other Than Customer Name: Owner Name: Owner Address: Owner Phone NOTE: NAME CHANGE ONLY: Final Reading does not need to be obtained due to name change only I am applying for service exclusively for the Service Address above. I agree to comply with all applicable Policies, Terms and Conditions of the Maine Public Utilities Commission and the Lewiston Water/Sewer Division. For questions regarding regulations on water & sewer, see the state of Maine Public Utilities Commission home page by visiting: http://www.state.me.us/mpuc/homepage.htm or call the utility office at 513-3003. Date Signature of Applicant This application does not obligate the Water/Sewer Divisions to grant your request. You will be notified in the event your application is rejected. For Office Use Only Reviewed By: Date: Acct # Route # Read Sequence Date Opened: Parcel ID : GIS ID : LUC : IMP. AREA :