High Point, NC · Guilford County
Utility Disconnect Affidavit
The Utility Disconnect Affidavit records that utilities have been disconnected before a structure is removed, and is completed by the property owner and contractor applying for the removal permit.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
High Point’s form records the structure’s location and the property owner’s information, and asks the applicant to acknowledge that utilities have been properly disconnected. It is used with a permit to remove a structure; the form also requires the contractor’s printed name, signature, and date under “Authority to File.” The affidavit includes a notary section for the contractor’s sworn or affirmed statement.
Who needs it
The contractor applying for a structure-removal permit needs this form, with the property owner’s information and acknowledgment that the utilities have been disconnected.
Why it needs a notary
The form has a “Sworn to (or affirmed) and subscribed before me” jurat; the contractor signing under “Authority to File” appears before the notary.
How to get this notarized
- 1
Download the Affidavit
Get High Point’s Utility Disconnect Affidavit from the city’s document page.
- 2
Complete the Form
Enter the structure location and requested property owner information, identify applicable utility providers, and complete the contractor section.
- 3
Book an Online Notary
If the city accepts online notarization for this form, book a commissioned online notary and check signing requirements before the appointment.
- 4
Sign Before the Notary
The contractor signs the sworn or affirmed statement before the notary, who completes the jurat and notary fields.
- 5
Submit to the City
Submit the completed affidavit with the structure-removal permit application using the city’s instructions.
Preview the form
The blank PDF straight from High Point. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the Utility Disconnect Affidavit?
- Provide the requested property and structure information, identify applicable utility providers, and complete the contractor section. The contractor signs the sworn statement before a notary.
- Do I need a notary for this affidavit?
- Yes. The form includes a jurat requiring the statement to be sworn to or affirmed and subscribed before a notary public.
- Can I use a commissioned online notary for this form?
- North Carolina’s remote electronic notarization program has not launched. Emergency video notarization requires both the signer and notary to be in North Carolina and is not remote online notarization. Ask the city what it accepts; confirm with the city or town if unsure.
- Who signs the notary section?
- The contractor signs under “Authority to File” and appears before the notary for the sworn or affirmed statement. The form also provides spaces for the notary’s signature, printed name, commission expiration, and seal.