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WATER INFORMATION REQUEST REV. 05/2022 [PHONE REDACTED] 645 BEACON LITE ROAD [EMAIL REDACTED] MONUMENT CO 80132 FROM: STREET ADDRESS: COMPANY: SELLERS NAME: EMAIL: BUYERS NAME: PHONE CLOSING DATE: Billing Information: Current/Past Amount Due: Pro-Rate: From to ESTIMATE ONLY Total Balance IF CLOSING DATE CHANGES, PLEASE ADVISE FOR REVISED INFORMATION. Town Representative I, owner of the above-named property gives the Town of Monument permission to release the necessary billing information to the requestor. Current Owner Signature Note to SELLER: Please contact Town of Monument Water Office to fill out a Water Disconnect form. Note to BUYER: Please contact Town of Monument Water Office with a copy of your Warranty Deed and fill out a Water Connect form. SIGN