EmailMe Form - Sewage Billing Record Request Form

Name

First Last

Email *

Response will be returned electronically to the email address provided

Confirm

Property Details

Please provide property details below

Account Number if Known

Premise Number if Known

Account Holder Name

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Record(s) to be Included in Response:

Check here if you are looking for the active or most recently active account

The default response will be the current active or most recent active account unless a time frame is indicated below

OR:

Indicate the Time Frame for the Records Requested

MM / DD / YYYY

To

MM / DD / YYYY

I am: *

Please describe "Other":

Please read prior to submitting your request

By checking this box, I affirm that I am the property owner, manager, title search representative, other (as checked above), or have the express permission of the account holder and am authorized to receive this information.

By checking this box, I agree to accept the requested information electronically and delivered to the e-mail address provided above.

For printed copy of records (hardcopy), please email Legal@TerreHaute.IN.Gov and request a Public Information Request form.