West Milton, OH · Miami County
Utility Payment Extension Form
Water utility account owners or tenants use this form to request a payment extension and set out a schedule for paying the account balance.
What this form is
This form requests an extension for a utility account payment and records the account name, address, phone number, and reason for the request. It includes a payment schedule with due dates, amounts, and paid dates, and states that regular monthly water bills must still be paid alongside the scheduled payments. The owner or tenant signs the form.
Who needs it
An owner or tenant seeking an extension to pay a utility account balance can complete this form and provide a reason and proposed payment schedule.
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 form is signed and dated without a notary; the owner or tenant signs, and the form lists no notarized attachment or sworn step.
How to submit this form
- 1
Download The Form
Download the Utility Payment Extension Form PDF.
- 2
Complete Account Details
Enter the date, account name, address, phone number, and reason for the payment extension.
- 3
Add A Payment Schedule
Fill in the schedule with due dates, amounts, and paid dates.
- 4
Sign And Submit
Have the owner or tenant sign, then submit the form to the city department named on it.
Frequently asked questions
- What information does the Utility Payment Extension Form ask for?
- It asks for the date, account name, address, phone number, and reason for the payment extension. It also has a payment schedule for due dates, amounts, and paid dates.
- Do I need a notary for the Utility Payment Extension Form?
- No. The form has an owner or tenant signature line and does not include a notary block or identify a notarized attachment or sworn step.
- How do I submit the Utility Payment Extension Form?
- Submit it to the city department named on the form; check the city website for current contact details.
- Do I still have to pay my monthly water bill?
- Yes. The form says you must pay the regular monthly water bill in addition to the payment schedule. It also says the extension may be terminated and water may be discontinued if payment is not received.
Need something notarized?
This Utility Payment Extension Form doesn’t need a notary — but if you have another West Milton form that does, a commissioned online notary can help.