Log Cabin, TX · Henderson County
Personal Information Disclosure Request Form
City of Log Cabin utility customers use this form to authorize disclosure of personal account information or information about their utility usage, services, and billing.
What this form is
This form lets a City of Log Cabin Utilities Department customer request disclosure of personal information or utility usage, services, and billing information from their account record. The customer identifies their account and the person receiving the information, selects what may be disclosed, and signs and dates the form. It also includes an option to authorize release of account information to the public upon written request.
Who needs it
A City of Log Cabin Utilities Department customer who wants to authorize disclosure of account information should complete and return this form.
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 does not identify any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Personal Information Disclosure Request Form PDF.
- 2
Complete The Form
Enter the customer name and account number, select the information to disclose, and provide the recipient’s name, address, and driver’s license number.
- 3
Review Attachments
The form does not list any required attachments.
- 4
Sign And Submit
Sign and date the form, then return it to the City of Log Cabin Utilities Department.
Frequently asked questions
- Do I need a notary for the Personal Information Disclosure Request Form?
- No. The form calls for the customer’s signature and date and does not include a notary block or identify any notarized or sworn attachment.
- How do I submit the Personal Information Disclosure Request Form?
- The form says to return it to the City of Log Cabin Utilities Department but does not provide contact details. Check the city website for current submission information.
- What information can I authorize the city to disclose?
- You can select personal information, information about your utility usage, services, and billing, or both. The form also offers an option to authorize release of account information to the public upon written request.