Application for remission of
excess metered water charges
Please read this first
This form will be scanned by electronic equipment. It is important that you:
• use a blue or black pen to complete this form; and
• print clearly.
Please send this application to: Office Manager, Tararua Alliance, PO Box 7, Dannevirke 4942, or email to
accounts@tararuaalliance.co.nz. For more information, phone (06) 374 5341.
Office use only Standard: 80m³
Last meter reading
Quarter read Excess
Write-off recommended: 50%:
m³
OR
%
:
m³
tararua district council
•
26 gordon street
•
po box 115
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dannevirke 4942
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06 374 4080
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info@tararuadc.govt.nz
Applicant details (Please print in CAPITALS)
Mr Mrs Miss Ms
I,
Full name of applicant
of
Postal address
apply for remission of excess metered water charges in respect of the property described in valuation references:
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Information to support the remission of excess metered water charges
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2 0
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2 0
Date water leak was identied Date the leak was repaired (provide proof of water leak being repaired)
How was the water leak identied? (Attach separate pages for detailed explanation, if required.)
Nature of the water leak. (Attach separate pages for detailed explanation, if required.)
Is this the rst request for remission for the nancial year? Yes No
Signature
/ /
2 0
Signature of applicant Date
click to sign
signature
click to edit
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