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Enter account number found on utility bill xxxxx-xxxxx (leave out preceding zeroes.
Enter property address where utility service is provided.
Enter if applicable or leave blank
Enter name of business if applicable
Enter the address where the utility bill should be sent or duplicate bill if tenant is responsible for payment.
Complete this section ONLY if utility payment is tenant responsibility
For the purposes of Act 25, Wis. Stat. §196.137, and compliance with federal and state laws regarding the inspection and release of utility documents, I hereby authorize the use or disclosure of my utility information as described in this authorization.
Please state the purpose of the request. If you are the individual initiating this authorization and you do not wish to state a purpose, please state "At the request of the individual."
Enter date or event
6300 West McGeoch Avenue,
West Allis, WI 53219
This field is not part of the form submission.
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