Lorena, TX · McLennan County
Special Notice Right of Confidentiality of Personal Information
This form lets a City of Lorena utility customer request confidentiality for personal information or rescind a prior confidentiality request.
What this form is
The notice says a customer of a government-operated utility may submit a written request for confidentiality of their address, telephone number, and Social Security number. Use the detachable portion to request confidentiality or rescind a prior request. It asks for the customer’s name and account number, plus a signature and date.
Who needs it
A City of Lorena utility customer who wants to request confidentiality for personal information or rescind a previous request should use this form.
How to submit it
Cut off and return the completed bottom portion by mail to City of Lorena, 107-A S Frontage Road, Lorena, TX 76655.
About notarization
This request is signed and dated without a notary; the document does not identify any notarized or sworn attachment.
How to submit this form
- 1
Download The Form
Download the personal information confidentiality notice PDF.
- 2
Complete The Request
Fill in your name and account number, then select whether you are requesting confidentiality or rescinding a prior request.
- 3
Sign And Date
Sign and date the bottom portion. The document does not list any attachments.
- 4
Return It To The City
Cut off the completed portion and return it to the City of Lorena at the address printed on the form.
Frequently asked questions
- What does this form let a utility customer request?
- It lets a City of Lorena utility customer request confidentiality for their address, telephone number, and Social Security number, or rescind a prior request.
- How do I submit this confidentiality request?
- Complete, sign, and date the bottom portion, cut it off, and return it to City of Lorena, 107-A S Frontage Road, Lorena, TX 76655.
- Do I need a notary for this confidentiality request?
- No. The form calls for a signature and date, not notarization, and it does not identify any notarized or sworn attachment.
Need something notarized?
This Special Notice Right of Confidentiality of Personal Information doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.