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Water and Wastewater – Mailing Address Change

Name:

Telephone number:

Email Address:

Utility Account Number:

Municipal Address (Including Postal Code):

Preferred mailing address for the property noted above (Including Postal Code):

I hereby authorize the Municipality of Port Hope to change my mailing address to the address identified above. Please sign below:

Clear

Date:

Personal Information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 c. M56, as amended. Inquiries about the collection of personal information should be directed to the Municipal Clerk.

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Water and Wastewater – Mailing Address Change