Gaines, NY · Orleans County
Tenant Final Water Bill Request Form
Tenants use this form to request a final water bill from the Town of Gaines Water Department.
What this form is
This form lets a tenant request a final water bill and provides spaces for the request date, account number, final-read date, service and mailing addresses, and contact information. The tenant completes Section A, while the Town of Gaines Water Department completes Section B with meter details and the final read. The form notes that only the property owner can request termination of service and that restoring water service costs $75.
Who needs it
A tenant requesting a final water bill for a Gaines water account should complete Section A of this form.
How to submit it
The form lists the Town of Gaines at 14087 Ridge Road, Albion, NY 14411, with phone and fax numbers. It does not specify a submission method; check the town website for current contact details.
About notarization
This document is signed and dated by the tenant without a notary; it does not mention any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Tenant Final Water Bill Request Form.
- 2
Complete Section A
Enter the request and final-read dates, account and address details, phone numbers, and the tenant’s printed name and signature.
- 3
Review The Owner Notice
Note that only the property owner can request actual termination of service.
- 4
Submit To The Town
Use the Town of Gaines address, phone, or fax listed on the form to contact the town about submitting your request.
Frequently asked questions
- Do I need a notary for the Tenant Final Water Bill Request Form?
- No. The tenant signs and dates the form without a notary. The form does not mention any attachment or related step that must be notarized or sworn.
- How do I submit the Tenant Final Water Bill Request Form?
- The form lists the Town of Gaines at 14087 Ridge Road, Albion, NY 14411, and includes phone and fax numbers, but does not specify how to submit the request.
- Who completes each section of the form?
- The tenant completes Section A. The Town of Gaines Water Department completes Section B with meter identification, meter readings, and whether service is turned off.
- Can a tenant request termination of water service?
- The form states that only the property owner can request actual termination of service. It also notes a $75 fee to restore water service.
Need something notarized?
This Tenant Final Water Bill Request Form doesn’t need a notary — but if you have another Gaines form that does, a commissioned online notary can help.