Do I need a notary for the Leak Adjustment Request?

No. The request asks the resident to sign and date it without a notary. Include proof of repair, such as an invoice, receipt, or landlord letter.

How do I submit the Leak Adjustment Request?

Return the signed request and proof of repair to Town Hall by mail, email, overnight deposit box, or in person. The form says to submit before the first of the month following the leak.

What information does the Leak Adjustment Request ask for?

It asks for the resident’s name, address, leak date, estimated gallons leaked, signature, and date. Town Hall also uses the form to record review and meter information.

What proof of repair should I include?

The form gives examples: a plumber’s invoice or quote, a receipt for materials, or a landlord’s letter stating that a repair was made.

Sims, NC · Wilson County

No notary required

Leak Adjustment Request

Sims utility customers use this request to seek an adjustment to sewer usage charges after a leak, while remaining responsible for all water used.

What this form is

Use this request to ask Sims to adjust the sewer portion of a utility bill after a leak; the resident remains responsible for all water used or leaked. The form asks for the resident’s name, service address, leak date, estimated gallons, signature, and date. It states that only one leak adjustment is allowed per year and requests proof that the leak was repaired.

Who needs it

A Sims utility customer who experienced a leak and wants to request a sewer-usage adjustment should complete this form.

How to submit it

Return the signed request and proof of repair to Town Hall by mail, email, overnight deposit box, or in person. Submit before the first of the month following the leak.

About notarization

This request is signed and dated without a notary; the form asks for proof of repair, such as an invoice, receipt, or landlord letter, but no sworn attachment.

How to submit this form

1
Download The Form
Download the Leak Adjustment Request PDF.
2
Complete And Sign
Enter the resident’s name, address, leak date, estimated gallons leaked, and signature and date.
3
Gather Repair Proof
Include proof that the leak was repaired, such as a plumber’s invoice or quote, materials receipt, or landlord letter.
4
Submit To Town Hall
Return the request and proof to Town Hall by mail, email, overnight deposit box, or in person before the stated deadline.

Frequently asked questions

Do I need a notary for the Leak Adjustment Request?: No. The request asks the resident to sign and date it without a notary. Include proof of repair, such as an invoice, receipt, or landlord letter.
How do I submit the Leak Adjustment Request?: Return the signed request and proof of repair to Town Hall by mail, email, overnight deposit box, or in person. The form says to submit before the first of the month following the leak.
What information does the Leak Adjustment Request ask for?: It asks for the resident’s name, address, leak date, estimated gallons leaked, signature, and date. Town Hall also uses the form to record review and meter information.
What proof of repair should I include?: The form gives examples: a plumber’s invoice or quote, a receipt for materials, or a landlord’s letter stating that a repair was made.

Need something notarized?

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