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PICKENS COUNTY WATER AND SEWER AUTHORITY Phillip Dean Kris Stancil Director of Utilities Commissioner Chairman INFORMATION CHANGE ON WATER SERVICE ACCOUNT Information to change Account # Phone # Account Holder Service Address Forwarding Address Signature Date Signature Date Office Staff Signature Date 1266 East Church St.; Ste 117 Jasper, GA 30143 Phone [PHONE REDACTED] Fax [PHONE REDACTED] SIGN SIGN