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 Accounting Clerk Emily Light at elight@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*
Date Format: MM slash DD slash YYYY
Phone Number*
Alternate Number*
Date of Service Change*
Date Format: MM slash DD slash YYYY
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
Name
This field is for validation purposes and should be left unchanged.