Move Out Request Form

2. City of Blaine Move Out Form (Utility Disconnection)
   <p><font size ="2.5">This form is used to notify the Utility Billing staff of an upcoming move out (sale) of your current property. City staff will use the move out (sale) date as the last day of your service and prepare a final bill within 15 days after your closing. Staff will mail the final bill to the forwarding address provided. <p><br><b>If your closing is delayed or date changes please contact the Utility Billing staff as soon as possible. Utility Billing can be reached at 763-785-6141, Monday thru Friday, 8AM to 4:30PM.</p>

   This form is used to notify the Utility Billing staff of an upcoming move out (sale) of your current property. City staff will use the move out (sale) date as the last day of your service and prepare a final bill within 15 days after your closing. Staff will mail the final bill to the forwarding address provided.

   
   If your closing is delayed or date changes please contact the Utility Billing staff as soon as possible. Utility Billing can be reached at 763-785-6141, Monday thru Friday, 8AM to 4:30PM.

4. Move Out Date (Sale Date)*
   Move Out Date (Sale Date)
5. Did You:

   1. Own
   2. Rent
6. Existing Garbage Size

   1. 38 Gallon
   2. 68 Gallon
   3. 96 Gallon
8. Service Address*
10. Name*
11. Email Address
12. Phone Number*
14. Forwarding Address
16. Address*
18. City*
19. State*
20. Zip Code*
24. If known please provide the new owners name and phone number.

    If known please provide the new owners name and phone number.
26. New Owner Name
27. New Owner Phone Number
29. Notice
    You can consider this form accepted after you click submit. Your service will be ended on the date entered above. Staff will contact you if we have questions with the information provided.

    You can consider this form accepted after you click submit. Your service will be ended on the date entered above. Staff will contact you if we have questions with the information provided.
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit