Goshen, NY · Orange County
Water/Sewer Bill Penalty Waiver Form
This form lets a person request that a penalty on a water or sewer bill be waived by the Village of Goshen.
What this form is
Use this form to request a waiver of a penalty incurred on a water or sewer bill for a specified billing period. The person requesting the waiver provides account and contact details, then signs and dates the request. The Village completes the payment-history review and records whether the request is approved or denied; denied penalties will appear as arrears on the next regular bill.
Who needs it
A person seeking a waiver of a penalty on a Village of Goshen water or sewer bill should complete this form.
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 and dated without a notary; it lists no notarized attachment or sworn step.
How to submit this form
- 1
Download The Form
Download the Water/Sewer Bill Penalty Waiver Form.
- 2
Complete The Request
Enter the billing period and requested account and contact details, then sign and date the form.
- 3
Submit The Form
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Water/Sewer Bill Penalty Waiver Form?
- No. The form asks the requester to sign and date it, and it lists no notarized attachment or sworn step.
- How do I submit the Water/Sewer Bill Penalty Waiver Form?
- Submit it to the city department named on the form; check the city website for current contact details.
- What information does the form ask for?
- It asks for the billing period, account number, billing name, meter address, email address, phone number, signature, and date. The Village completes the review and decision sections.
Need something notarized?
This Water/Sewer Bill Penalty Waiver Form doesn’t need a notary — but if you have another Goshen form that does, a commissioned online notary can help.