Lithopolis, OH · Fairfield County
Disconnect Utility Form
Lithopolis utility customers use this notice to provide their last day of service, account details, forwarding address, and signature when discontinuing service.
What this form is
The Disconnect Service Notice tells Lithopolis when utility service should end and collects the customer’s name, service address, current mailing address, and forwarding address. The person discontinuing service provides a last day of service, telephone number, signature, and date. The form also has spaces for the landlord or landowner’s name and for office use, including the account number, service ID, receipt date, and final read.
Who needs it
A Lithopolis utility customer discontinuing service can use this notice to provide a last day of service and forwarding contact information.
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 or sworn attachment or related step.
How to submit this form
- 1
Download the Form
Download the Disconnect Utility Form PDF.
- 2
Complete the Notice
Enter the last day of service, customer and address details, forwarding address, and telephone number.
- 3
Sign and Date
Sign and date the notice; the form lists no required attachment.
- 4
Submit to the City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What information does the Disconnect Utility Form ask for?
- It asks for the last day of service, customer and service address details, forwarding address, telephone number, signature, and date.
- Who uses the Disconnect Utility Form?
- A Lithopolis utility customer discontinuing service can use the notice to provide a last day of service and forwarding contact information.
- Do I need a notary for the Disconnect Utility Form?
- No. The form has a signature and date line but no notary block or notarized attachment; the signer just signs and dates it.
- How do I submit the Disconnect Utility Form?
- Submit it to the city department named on the form; check the city website for current contact details.