What information does the Water Loss Protection Claim Form request?

It requests the owner's name, service address, water account number, dates of loss, leak type, repair information, and a signed statement about whether the leak was intentionally caused.

Do I need a notary for the Water Loss Protection Claim Form?

No. The form has no notary block. The owner swears or affirms the statement and signs and dates the form.

Do I need to include repair receipts?

The form notes that receipts are provided alongside the repair information.

Arnoldsville, GA · Oglethorpe County

No notary required

Water Loss Protection Claim Form

Property owners use this form to claim water loss protection by describing a leak, its repair, and the dates of loss.

What this form is

The City of Arnoldsville Water Loss Protection Claim Form records a property owner's claim about a water leak. It asks for the owner's name, service address, water account number, dates of loss, type of leak, repair information, and the owner's signed statement that the leak was not intentionally caused. The form includes a space for receipts to be provided.

Who needs it

A property owner making a water loss protection claim for a leak should complete the form and provide the repair receipts noted on it.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed without a notary; the owner swears or affirms the statement and signs and dates the form.

How to submit this form

1
Download The Form
Download the Water Loss Protection Claim Form PDF.
2
Complete The Claim Details
Enter the owner and service information, dates of loss, leak type, and repair information.
3
Gather Repair Receipts
Provide the receipts noted on the form.
4
Sign And Submit
Swear or affirm the statement, sign and date the form, and submit it to the city department named on the form.

Frequently asked questions

What information does the Water Loss Protection Claim Form request?: It requests the owner's name, service address, water account number, dates of loss, leak type, repair information, and a signed statement about whether the leak was intentionally caused.
Do I need a notary for the Water Loss Protection Claim Form?: No. The form has no notary block. The owner swears or affirms the statement and signs and dates the form.
How do I submit the Water Loss Protection Claim Form?: Submit it to the city department named on the form; check the city website for current contact details.
Do I need to include repair receipts?: The form notes that receipts are provided alongside the repair information.

Need something notarized?

This Water Loss Protection Claim Form doesn’t need a notary — but if you have another Arnoldsville form that does, a commissioned online notary can help.