Keene, TX · Johnson County
Leak Adjustment Request Form
Keene water customers use this form to request a bill adjustment after a leak and provide details about the leak and its repair.
What this form is
Use this form to ask Keene for a water and wastewater bill adjustment after a leak on the customer’s side of the meter. The form says requests must be received within 10 calendar days of receiving the bill, and adjustments are available no more than once annually. It asks for customer and account details, leak dates, a repair explanation, signatures, and repair receipts or parts receipts for self-repairs.
Who needs it
A Keene water customer requesting a leak-related bill adjustment should complete the form and provide the repair documentation described in it.
How to submit it
Return the completed form to Keene City Hall, 1000 N. Old Betsy Rd, Cleburne, Texas 76031; the form also lists fax 817-556-2060 and [email protected].
About notarization
This form is signed and dated without a notary; it requires repair receipts or a written explanation and parts receipts for self-repairs, but no sworn or notarized attachment.
How to submit this form
- 1
Download The Form
Download the Leak Adjustment Request Form PDF.
- 2
Complete The Form
Enter customer and account information, leak detection and repair dates, and a brief explanation of the repairs.
- 3
Gather Repair Documentation
Attach the repair or invoice payment receipt; for self-repairs, include a written explanation and receipts for repair parts.
- 4
Sign And Submit
Sign and date the form, then return it to Keene City Hall using a submission method listed on the form.
Frequently asked questions
- Do I need a notary for the Leak Adjustment Request Form?
- No. The form asks the customer to sign and date it but does not require a notary. Repair receipts or the listed self-repair documentation are still required.
- How do I submit the Leak Adjustment Request Form?
- Return it to Keene City Hall at 1000 N. Old Betsy Rd, Cleburne, Texas 76031. The form also lists fax 817-556-2060 and [email protected].
- What documentation should I include?
- Include a copy of the repair or invoice payment receipt. For self-repairs, provide a brief written explanation of the repairs and copies of receipts for repair parts.
- When must I request a leak adjustment?
- The form says the city must receive the request within 10 calendar days after you receive your bill. It also states that an adjustment is available no more than once annually.
Need something notarized?
This Leak Adjustment Request Form doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.