What is the Gladstone Utility Lien Waiver for?

It provides the City of Gladstone written notice that a tenant has agreed with the owner to be responsible for utility charges at the service address.

What should I attach to the utility lien waiver?

Attach a true copy of any written lease for the affected premises. The form says copies or facsimiles of the form itself will not be accepted.

How do I submit the Utility Lien Waiver?

Send the original form to the City of Gladstone at 1100 Delta Avenue, Gladstone, MI 49837, with a true copy of any written lease.

Gladstone, MI · Delta County

No notary required

Lien Waiver (Utility Responsibility for Payment)

Tenants and property owners use this form to notify the City of Gladstone that a tenant is responsible for utility charges at a service address.

What this form is

This form gives the City of Gladstone written notice that a tenant has agreed with the property owner to pay utility charges for a service address. It requests tenant, owner, service, and account details, and requires signatures from the tenant and owner. Attach a true copy of any written lease. The second page section authorizes release of tenant account and personal information to a landlord and is held until needed.

Who needs it

Tenants and property owners use this form when the tenant is responsible for utility charges and the city needs written notice of that arrangement.

How to submit it

Send the original document to the City of Gladstone, 1100 Delta Avenue, Gladstone, MI 49837, with a true copy of any written lease. Copies and facsimiles are not accepted.

About notarization

This document is signed without a notary; attach a true copy of any written lease, and obtain the listed tenant, owner, and witness signatures and dates.

How to submit this form

1
Download The Form
Download the City of Gladstone Lien Waiver (Utility Responsibility for Payment).
2
Complete The Form
Fill in the tenant, service address, account, and owner details, then obtain the required signatures and dates.
3
Gather The Lease Attachment
Attach a true copy of any written lease for the affected premises.
4
Submit The Original
Send the original form and lease copy to the City of Gladstone, 1100 Delta Avenue, Gladstone, MI 49837.

Frequently asked questions

What is the Gladstone Utility Lien Waiver for?: It provides the City of Gladstone written notice that a tenant has agreed with the owner to be responsible for utility charges at the service address.
What should I attach to the utility lien waiver?: Attach a true copy of any written lease for the affected premises. The form says copies or facsimiles of the form itself will not be accepted.
Do I need a notary for the Utility Lien Waiver?: No. The document is signed without a notary. Attach a true copy of any written lease and obtain the listed tenant, owner, and witness signatures and dates.
How do I submit the Utility Lien Waiver?: Send the original form to the City of Gladstone at 1100 Delta Avenue, Gladstone, MI 49837, with a true copy of any written lease.

Need something notarized?

This Lien Waiver (Utility Responsibility for Payment) doesn’t need a notary — but Michigan residents can notarize other documents online with a commissioned online notary.