Do I need a notary for the Water Leak Adjustment Request Form?

No. The form asks the customer to sign and date it, but does not require a notary. Include copies of repair documentation, such as receipts.

How do I submit the Water Leak Adjustment Request Form?

Submit the completed, signed form and copies of repair documentation to the City of Republic at 987 S. Clark Ave, P.O. Box 331, Republic, WA 99166.

What information does the form ask for?

It asks for customer and account details, service and mailing addresses, when the leak was discovered and repaired, how it was found and fixed, available repair documentation, and the customer's signature and date.

What repair documentation should I include?

The form asks what documentation is available as proof of repair and instructs customers to submit copies of documentation, such as receipts.

Republic, WA · Ferry County

No notary required

Water Leak Adjustment Request Form

Republic water customers use this form to request a City Council adjustment after repairing a leak and providing documentation of the repair.

What this form is

This form lets a Republic water customer request a City Council adjustment for a water leak and provide details about the leak, its discovery and repair, and available proof of repair. The accompanying policy describes eligibility criteria, including repair and request timelines, and says the Council may approve or deny a request. The form asks for customer and account details, dates, a signature, and repair documentation.

Who needs it

A Republic water customer seeking a leak adjustment should complete this form and provide documentation showing that the leak was repaired.

How to submit it

Submit the completed, signed form and copies of repair documentation, such as receipts, to the City of Republic at 987 S. Clark Ave, P.O. Box 331, Republic, WA 99166.

About notarization

This document is signed and dated without a notary; the form requests repair documentation, such as receipts, but does not require a sworn or notarized attachment.

How to submit this form

1
Download the Form
Download the Water Leak Adjustment Request Form.
2
Complete the Form
Provide the requested customer, account, leak discovery, and repair details, then sign and date the form.
3
Gather Repair Documentation
Make copies of available proof of repair, such as receipts, to submit with the form.
4
Submit to the City
Send the signed form and copies of repair documentation to the City of Republic at the address listed on the form.

Frequently asked questions

Do I need a notary for the Water Leak Adjustment Request Form?: No. The form asks the customer to sign and date it, but does not require a notary. Include copies of repair documentation, such as receipts.
How do I submit the Water Leak Adjustment Request Form?: Submit the completed, signed form and copies of repair documentation to the City of Republic at 987 S. Clark Ave, P.O. Box 331, Republic, WA 99166.
What information does the form ask for?: It asks for customer and account details, service and mailing addresses, when the leak was discovered and repaired, how it was found and fixed, available repair documentation, and the customer's signature and date.
What repair documentation should I include?: The form asks what documentation is available as proof of repair and instructs customers to submit copies of documentation, such as receipts.

Need something notarized?

This Water Leak Adjustment Request Form doesn’t need a notary — but if you have another Republic form that does, a commissioned online notary can help.