City of Port Washington - Move Out

Move In/Move Out Form (Homeowners Only)

City of Port Washington Water & Sewer Utility
Name *

First Name Last Name
Name (If Needed)

First Name Last Name
Name (If Needed)

First Name Last Name

Address (where you are moving FROM)

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

Phone Number

- Area Code Phone Number
Account Number
Water/Sewer Account Number (ex: 0-00000000-00)
Closing Date

- Month - Day Year
Is The Pending Water Bill at the Residence being Prorated (Check With Your Title Company)
Name of Person Buying Home

First Name Last Name
Name of Person Buying Home (If Needed)

First Name Last Name
Name of Person Buying Home (If Needed)

First Name Last Name
House Not Sold (Is Vacant)

Yes No

Forwarding Address (where you are moving TO)

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

Additional Information

Address (where you moving TO)

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

Phone Number

- Area Code Phone Number
Closing Date

- Month - Day Year
Is The Pending Water Bill at the Residence being Prorated (Check With Your Title Company)
Name of Person You Bought Home From

First Name Last Name
Name of Person You Bought Home From (If Needed)

First Name Last Name
Name of Person You Bought Home From (If Needed)

First Name Last Name
Additional Information
Enter the message as it's shown *
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