Utility Service Handover Certificate Form

Utility Service Handover Certificate Form
Complete this form to officially document the transfer of utility services from one party to another.
Property or Service Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Type of Utility Service
Other
Outgoing Party Full Name
First NameLast Name
Outgoing Party Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Incoming Party Full Name
First NameLast Name
Incoming Party Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Handover Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Utility Account or Reference Number(s)
Meter Reading(s) at Handover (if applicable)
Remarks or Special Instructions
Should be Empty: