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2. 
4. Dear Property Owner,
6. The City of St. Cloud shows that you own property in St. Cloud. Please complete this form if you would like the utility account to be put in the name of the person who is claiming homestead status for the property in which you own.
8. By state statute (MN Stats 116A.22; 279.01; & 444:075 subd 3[c]), and city ordinance code (245:10; 575:01, 20), utility bills are attached to the property, not the occupant, in the same manner as real estate taxes. An annual certification process assesses delinquent accounts that remain unpaid as of July 1st to the property taxes.
10. City Ord: Section 575:01 “All accounts shall be carried in the name of the owner who personally, of by his/her authorized agent, applied for such service. The owner shall be liable for water and sewer services supplied to the property, whether he or she is occupying the property or not, and any unpaid charges shall be a lien upon the property.”
12. Service Address*
14. Billing Name*
16. Billing Address*
17. City, State, Zip*
19. Phone Number*
20. Email*
22. I authorize the City of St. Cloud to send current and future utility bills to the relative homestead or managing company. I understand this will remain in effect until I notify the billing department in writing.
24. Owner Name*
25. Date*
27. Owner Street Address, City, State, Zip*
29. Owner Signature if printing form; otherwise sign electronically below.
31. Additional Comments
33. Privacy Policy
    The Minnesota Data Privacy Act requires that we inform you of your rights about the private data we are requesting on this form. The following data contained on this form will be considered private data pursuant to M.S. 13.548: the name, address, telephone number, any other data that identifies the individual, and any data that describes the health or medical condition of the individual, family relationships, and living arrangements of an individual or which are opinions as to the makeup or behavior of an individual. We need this data to register you for a program and to contact you if necessary. City of St. Cloud staff will have access to the data you provide to administer the program. You are not legally required to provide the data; however, refusing to supply the data may cause your registration to not be processed. Your acceptance here indicates you have read and understand these rights.
35. Authorization & Privacy Policy*

    1. By checking this box & typing my name below, I am electronically signing my request, & have read and agree to the data privacy policy.
37. First Name*
38. Last Name*
40. FINANCE DEPARTMENT
    Utility Billing 320/255.7211
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field