Grandview, TX · Johnson County
CareFlite Caring-Heart Membership Opt-Out Form
Grandview utility account holders use this form to opt out of the $1 monthly fee for the CareFlite Caring-Heart Membership.
What this form is
This form lets an authorized Grandview utility account holder opt out of the $1 monthly CareFlite Caring-Heart Membership fee. It asks for the account holder’s name, address, utility account number, signature, and date, and includes a section for a city official to witness the signature. The form states that the fee is removed after the next billing cycle and that opting out ends household benefits.
Who needs it
An authorized Grandview utility account holder who wants the Caring-Heart Membership fee removed from their account should complete this form.
How to submit it
File the form at City Hall. The document states that the fee is removed at the conclusion of the next billing cycle.
About notarization
No notary is required; the account holder signs and dates the form, and a city official witnesses and dates the signature.
How to submit this form
- 1
Download The Form
Download the CareFlite Caring-Heart Membership Opt-Out Form.
- 2
Complete The Account Details
Enter your name, address, city, state, ZIP code, and utility account number.
- 3
Sign And Date
Sign and date the form; a city official witnesses and dates the signature.
- 4
File At City Hall
File the completed form at City Hall. The form does not list attachments.
Frequently asked questions
- What does the CareFlite Caring-Heart Membership Opt-Out Form do?
- It lets an authorized Grandview utility account holder opt out of the $1 monthly Caring-Heart Membership fee. The form states that opting out ends household program benefits.
- Do I need a notary for the CareFlite opt-out form?
- No. The account holder signs and dates the form, and a city official witnesses and dates the signature; no notary is required.
- How do I submit the CareFlite opt-out form?
- File the completed form at City Hall. The document says the fee is removed at the conclusion of the next billing cycle.