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Authorization to Make Changes

  1. CITY OF FATE LOGO

  2. Authorization to Make Changes

  3. Change of Address:

    I hereby request and authorize the City of Fate to change my mailing address. A copy of a drivers license or ID is required, this can be provided in office, emailed, faxed, mailed or in the drop box.

  4. Add Additional Account Holder:

    I hereby request and authorize the City of Fate to add the following name to my utility account. A copy of the current and additional account holder's drivers license or ID is required, these can be provided in office, emailed, faxed, mailed or in the drop box.

  5. Confidential Request:

    I hereby do request that the utility record information as authorized by H.B. 859 be kept confidential and that such information only be disclosed to those persons or entities authorized to receive such information by the statute.

  6. Remove Confidential Request:

    I hereby do request to remove the confidentiality status on my utility account.

  7. Internal Use Only

  8. Date: _____________________

  9. Received by: ____________________

  10. Phone: 972-771-4601 Opt 2

  11. E-Mail: utilities@cityoffate.com

  12. Fax: 972-722-8266

  13. Leave This Blank:

  14. This field is not part of the form submission.