Stop or Transfer Municipal Services

Please fill out and submit the form below to stop or transfer municipal services. Alternatively, you may print out this form and email to aleopard@adeliowa.org and jsteele@adeliowa.org. You may also return the completed form to City Hall. If you print the form, please complete the highlighted sections only.

Name*
First Last
Name Change on Account*
First Last
Date of Request*
Phone Number*
Alternate Number*
Date of Service Change*
Address of New Service*
Street Address Address Line 2 City State ZIP Code
Address for Final Read*
Street Address Address Line 2 City State ZIP Code
Which best describes the address you are suspending service from?*
- Purchasing
- Renting
- Sold
Landlord*
First Last
Previous Owner*
First Last
New Owner*
First Last
Moving From*
Street Address Address Line 2 City State ZIP Code
Address to Send Final Bill*
Street Address Address Line 2 City State ZIP Code
Phone
This field is for validation purposes and should be left unchanged.