East Hampton, NY · Suffolk County
Affidavit for Electrical Disconnect
Property owners and electricians use this affidavit to certify that electrical service to a property has been disconnected from PSEG.
What this form is
The Town of East Hampton Building Department uses this affidavit to document an electrical disconnect at a property. It asks for the property and owner details, PSEG account number, disconnect date, electrician’s name and Suffolk County electrical license number, and the owner’s and electrician’s signatures. The form includes a warning about false statements and an owner indemnity agreement.
Who needs it
Property owners and electricians completing an electrical disconnect at a property in East Hampton use this affidavit to provide their information and certifications.
How to submit it
Submit it to the Town of East Hampton Building Department at 300 Pantigo Place, Suite 104, East Hampton, New York 11937; the form lists 631-324-4145.
About notarization
This affidavit is signed without a notary; it lists no notarized attachment or sworn step, so the owner and electrician sign and date it.
How to submit this form
- 1
Download the Affidavit
Download the Electrical Disconnect Affidavit PDF.
- 2
Complete the Property Details
Enter the property address, hamlet, owner and tax map details, PSEG account number, disconnect date, and electrician information.
- 3
Review the Certification
Read the certification, owner agreement, and warning about false statements.
- 4
Sign and Submit
Have the owner and electrician sign and date the affidavit, then submit it to the Town of East Hampton Building Department.
Frequently asked questions
- What does the Electrical Disconnect Affidavit certify?
- The electrician certifies that the listed property has been disconnected from PSEG. The affidavit also includes the owner’s agreement to release and hold harmless the Town in connection with the disconnection.
- Who signs the affidavit?
- The form includes spaces for both the property owner and electrician to sign and date. It also requests the electrician’s Suffolk County Electrical License number.
- Do I need a notary for the Electrical Disconnect Affidavit?
- No. The document has no notary block or notarized attachment; the owner and electrician sign and date it.
- How do I submit the Electrical Disconnect Affidavit?
- Submit it to the Town of East Hampton Building Department at 300 Pantigo Place, Suite 104, East Hampton, New York 11937. The form lists 631-324-4145.
Need something notarized?
This Affidavit for Electrical Disconnect doesn’t need a notary — but if you have another East Hampton form that does, a commissioned online notary can help.