Dilley, TX · Frio County
Request for Relinquish of Account and Deposit(s)
This form lets a Dilley customer request relinquishment of an account and its deposit when the account is disconnected.
What this form is
The form records a customer’s request to relinquish an account and deposit, effective on the date entered. It states that the customer will not be responsible for the account or deposit returns after disconnection and includes spaces for the customer’s name, signature, address, account name, and account number. The document also contains USDA nondiscrimination statements and guidance.
Who needs it
A Dilley customer who wants to request relinquishment of an account and deposit after the account is disconnected needs this form.
How to submit it
The form lists the City of Dilley at P.O. Drawer 230, 101 South Commerce, Dilley, Texas 78017, and provides a phone number and fax number.
About notarization
This document is signed without a notary; it includes no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Dilley Request for Relinquish of Account and Deposit(s) PDF.
- 2
Complete the Form
Enter the customer and account information requested and sign the form.
- 3
Check for Attachments
The document does not list any customer attachments to gather.
- 4
Submit to the City
Use the City of Dilley mailing address or fax number printed on the form.
Frequently asked questions
- What does the Dilley Relinquish Deposits Form do?
- It records a customer’s request to relinquish an account and deposit and states that the customer will not be responsible for the account or deposit returns after disconnection.
- Who should use this form?
- A Dilley customer requesting relinquishment of an account and deposit after disconnection can use the form. It asks for customer and account details and a signature.
- Do I need a notary for the Dilley Relinquish Deposits Form?
- No. This document is signed without a notary and includes no notarized or sworn attachment; the signer just signs and dates it.
- How do I submit the Dilley Relinquish Deposits Form?
- The form lists the City of Dilley’s mailing address at P.O. Drawer 230, 101 South Commerce, Dilley, Texas 78017, and provides a fax number.