Form Builder

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Owner's Release Form

With reference to tenants vacating properties listed below, under the ownership of:

Owner information

By providing your e-mail address, the City of Medicine Hat will send an e-mail notification to the Owner when a transfer of utilities is scheduled.

Is there a Property Management Company responsible for the utility bills?

This letter shall serve as permission for the City of Medicine Hat to sign on utilities in the above mentioned name during vacant periods of time, with no further notice to the owner. It does not come into effect should the address be disconnected due to non-payment by the tenant.

PLEASE NOTE: You must notify our office in writing once you have sold the below listed properties or you will be held responsible for any utilities consumed during vacant periods.

Automatic Withdrawal (EFT)
Automatic Withdrawal (EFT)
Automatic Withdrawal (EFT)

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.