Disconnect and Reconnect Gas Fee Charge

Dilley customers use this form to acknowledge the listed charges for temporarily disconnecting and reconnecting a gas meter.

What this form is

This form records a customer's understanding that the City of Dilley will charge the account $21.00 to temporarily disconnect a gas meter and $21.00 to reconnect it. It includes space for the customer's residence, signature and date, employee information, turn-off and turn-on dates, and amounts paid.

Who needs it

A customer requesting temporary disconnection and reconnection of a gas meter uses this form to acknowledge the charges.

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 without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.

How to submit this form

1
Download The Form
Download the City of Dilley gas disconnect and reconnect form.
2
Complete The Form
Enter the residence information and complete the customer, date, employee, service-date, and amount-paid fields as applicable.
3
Sign And Date
The customer signs and dates the document to acknowledge the listed charges.
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

Do I need a notary for the Gas Disconnect and Reconnect form?: No. This document is signed without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How do I submit the gas disconnect and reconnect form?: Submit it to the city department named on the form; check the city website for current contact details.
What charges does the form list?: It states that the City of Dilley will charge the account $21.00 to temporarily disconnect the gas meter and $21.00 to reconnect it.
What information does the form request?: It provides spaces for the customer's residence, signature and date, employee information, turn-off and turn-on dates, and amounts paid.

Need something notarized?

This Disconnect and Reconnect Gas Fee Charge doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.