Do I need a notary for the Water Leak Adjustment Request Form?

No. The form has a customer signature and date line but no notary block. It lists repair records and other supporting documents, with no notarized or sworn attachment.

What documentation does the request require?

The form lists a bill showing excessive usage and repair documentation: an invoice if professionally repaired, receipts if repaired by the owner or tenant, or a data log showing the leak is repaired if capable.

Does submitting the form guarantee a bill credit?

No. The form says a credit is not guaranteed. Requests are automatically denied if required documentation is missing, and the customer will be notified if the request cannot be granted or more information is needed.

Chesterfield, NY · Essex County

No notary required

Water Leak Adjustment Request Form

Town of Chesterfield customers use this form to request a utility bill adjustment after a water leak and provide information about the leak and its repair.

What this form is

This form lets a customer request a reduction to a utility bill after a water leak; submitting it does not guarantee a credit. The customer provides their name, service address, account number, contact number, leak and repair dates, leak type, and a brief description of the repair. Required documentation includes a bill showing excessive usage and repair records or a data log, as applicable.

Who needs it

A Town of Chesterfield water customer seeking a utility bill reduction after a leak can submit this form with the required documentation.

How to submit it

Mail the form and all documentation to Town of Chesterfield, ATTN: Water, PO Box 456, Keeseville, NY 12944, or email them to [email protected].

About notarization

This request is signed and dated without a notary; the form lists no notarized or sworn attachment, so the customer just signs and dates it.

How to submit this form

1
Download The Form
Download the Water Leak Adjustment Request Form.
2
Complete The Form
Enter your account and contact information, leak and repair dates, leak type, and a brief description of the leak and repair.
3
Gather Required Documentation
Include the excessive-usage bill and applicable repair invoice, repair receipts, or data log showing the leak is repaired.
4
Sign And Submit
Sign and date the form, then mail it with all documentation to the Water address listed or email it to the clerk.

Frequently asked questions

Do I need a notary for the Water Leak Adjustment Request Form?: No. The form has a customer signature and date line but no notary block. It lists repair records and other supporting documents, with no notarized or sworn attachment.
How do I submit the Water Leak Adjustment Request Form?: Send the form and all required documentation by mail to Town of Chesterfield, ATTN: Water, PO Box 456, Keeseville, NY 12944, or email them to [email protected].
What documentation does the request require?: The form lists a bill showing excessive usage and repair documentation: an invoice if professionally repaired, receipts if repaired by the owner or tenant, or a data log showing the leak is repaired if capable.
Does submitting the form guarantee a bill credit?: No. The form says a credit is not guaranteed. Requests are automatically denied if required documentation is missing, and the customer will be notified if the request cannot be granted or more information is needed.

Need something notarized?

This Water Leak Adjustment Request Form doesn’t need a notary — but if you have another Chesterfield form that does, a commissioned online notary can help.