DES MOINES WATER WORKS OWNER FORM

DES MOINES WATER WORKS OWNER FORM

LIEN EXEMPTION | REQUEST FOR NOTICE TO OWNER | CHANGE OF ACCOUNT (OWNER RESPONSIBLE)
Please check the appropriate box(es). If form is not completed, it will be returned.
LIEN EXEMPTION

The undersigned represents that he or she is the landlord of the separately metered, residential or commercial, rental property identified below and that such property is occupied or is about to be occupied by the tenant identified below. Furthermore, the undersigned represents that the tenant is not a contract buyer. The undersigned requests an exemption on a residential property from the possibility of a lien for water, or City of DM sewer, solid waste and stormwater services, or on a commercial property the possibility of a lien for water services only to such property in accordance with section 384.84, Code of Iowa. For residential property, a new written notice must be received within thirty business days of a change in occupancy or change in ownership. For commercial property, a new written notice must be received within ten business days of a new tenant or a change in ownership.
REQUEST FOR NOTICE TO OWNER

Pursuant to sections 384.84(2)(c) and 384.84(3)(c), Code of Iowa as amended, and Section 502.3.1.2 of the Des Moines Water Works Rules and Regulations, the undersigned hereby represents that he or she is the owner of record on the property identified below, and hereby requests that he or she is given notice to the mailing address indicated below of any delinquent utility charges.
CHANGE OF ACCOUNT (OWNER RESPONSIBLE)

As the owner of the listed property below, the undersigned authorizes water service to be automatically put into his/her name upon the request for a final billing from the existing tenant. Owners will be notified by mail when this change takes place.
SERVICE ADDRESS*
Address / City / State / Zip
LANDLORD INFORMATION: REQUIRED FOR ALL SELECTIONS
Name*
Landlord Mailing Address*
Address / City / State / Zip
Phone Number*
Landlord Email*
example@example.com
TENANT INFORMATION: REQUIRED FOR LIEN EXEMPTION ONLY
Name*
Second Name
Date of Occupancy*

MonthDayYear
Phone Number*
Signature of Landlord*

Clear
Date*

MonthDayYear
*** You will receive a confirmation letter within 30 days of receiving form.***

Please contact us immediately if letter is not received within 30 days of submission.
Should be Empty:

DES MOINES WATER WORKS OWNER FORM

LANDLORD INFORMATION: REQUIRED FOR ALL SELECTIONS

TENANT INFORMATION: REQUIRED FOR LIEN EXEMPTION ONLY