2. CITY OF MINNEAPOLIS UTLITY DISCONNECTION FORM
4. Date
6. First Name
7. Last Name
9. Account Number
11. Address to Disconnect
13. Move Out Date
15. Utilities Disconnecting

    1. Water/Sewer
    2. Electric
17. Address for Last Bill to be Mailed to
19. Phone Number
21. Acknowledgement of Responsiblity

    I acknowledge that the final bill is still my responsibbility to pay. Any unpaid balance left on this account all reasonable incurred collection, attorney fees, and court costs will be added to the balance.

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

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