Residential Service Removal Request Form

Please read the information and instructions available on the website before completing this form

Please enter the following information:

* Please be advised that the Proof Of Ownership for the property will be required in order to proceed with your Demolition Request. Please attach appropriate document. Some examples of Proof of Ownership includes Property Deed, Property Tax Documentation, or HUD Document.

(of building to be demolished)

BY SUBMITTING THIS FORM YOU ARE CERTIFYING THAT YOU ARE AUTHORIZED TO REQUEST REMOVAL OF ELECTRIC AND GAS SERVICES AT THE PROPERTY SPECIFIED AND THAT PREMISE IS VACANT.

UPON SUBMISSION OF THIS FORM YOU WILL RECEIVE A CONFIRMATION NUMBER, PLEASE PRINT OR WRITE THIS DOWN FOR FUTURE REFERENCE.