Name Change Request Form

I do hereby request that the above name change be made on your records, and accept full responsibility for payment of all sewer bills henceforth for the above referenced property. If the account becomes delinquent to the point that additional collection measures need to be taken, such as water termination, filing of a municipal lien, civil complaint, etc, I understand and agree that all record owners of the property, regardless of whether his/her/their name appears on the invoice, will be responsible to the Hamilton Township Municipal Authority for any balance owed.