Fillable Instructions: 1. Complete this agreement in its entirety (City of Veneta)

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Instructions: 1. Complete this agreement in its entirety (City of Veneta)

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The Instructions: 1. Complete this agreement in its entirety (City of Veneta) form is 2 pages long and contains:

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  • 22 check-boxes
  • 40 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Veneta

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Instructions: 1. Complete this agreement in its entirety and sign.
2. Submit agreement to City by one of the following methods:
a) In person: 88184 8th Street , Veneta c) Mail to: P.O. Box 458, Veneta, OR 97487
b) Fax to: (541) 935-1838 Attn: Utility Billing
Last 4-digits of Social Security #: Month and Year of Birth: Last 4-digits of Social Security #: Month and Year of Birth:
Main: Main:
Is there a Co-Owner for any of your Veneta properties? (circle one)
Yes No If yes, complete Section B of this agreement
Do you use a property management company for your properties? Phone Numbers:
Business:
Yes No If yes, complete Section C of this agreement
Date Purchased
Yes No Yes No
Yes No Yes No
Yes No Yes No
(a)
(b)
(c)
(d)
I/We would like the City to continue services whenever the structure at the above service address(es) is/are vacant. I/We
understand that I/we will be the Responsible Party for the payment for all services rendered by the City until the City has received and
approved an application for services from another Responsible Party.
I/We would like the account to remain in my name even when occupied by someone other than myself. The deposit will be waived.
I acknowledge and agree that I/we will be the Responsible Party for the payment for all services rendered by the City to the service
address(es) above until I/we notify the City otherwise, in writing.
I/We allow tenant's to have an account in their name . I/we understand that they will be charged a utility deposit and that I/we will
receive copies of the tenants Past Due Notice and other delinquent account notices and that services shall be discontinued without
further notice if the account remains unpaid after the due date on the Past Due Notice. I/we further understand that service will only be
restored after all charges, fees, penalties, interest and deposits billed or billable have been paid in full.
Check (c) or (d):
I/We would like the City to discontinue services whenever the structure at the above service address(es) is/are vacant.
AGREEMENT CONTINUED ON BACK
Section A: Property Owner's Information
Section B: Co-Owner's Information
Full Name:
Full Name:
Contact Person/Dept.:
Mailing Address:
Mailing Address:
Street Address:
Street Address:
Phone Numbers:
Phone Numbers:
Current Employer's Name:
Emergency Contact: (Name and Phone #)
Property Owners' Direction to City
Section C: Property Management Company's Information
Company Name:
Properties Covered (Include a separate page if you have more than 3 properties)
Joint Ownership?
Alternate #:
Employer's Phone #:
Owner Agreement for
Rental Property
Mailing Address:
Federal Identification #:
Service Address
PO Box 458 * Veneta, OR 97487 * 541-935-2191 * Fax 541-935-1838 * www.venetaoregon.gov
Alternate #:
Alternate #:
Check (a) or (b):
S:\FORMS\Utility Billing\Property Owner Agreement.xlsx 3/12/2020
(e)
(f)
Date:
Date:
Act#:
Co-Owner's Signature:
My/Our signature below evidences my/our understanding of the terms of this agreement between the City of Veneta and myself. I/We understand
and agree that the financial responsibility for Utility and Other Services rendered to the address(es) listed above on behalf of the current and any
future non-owner residents or occupants can be transferred to me/us as owner of the real property. I agree to this arrangement and understand
that this transfer of financial responsibility shall be made by entering the unpaid Utility Account balances as a lien in the City's lien docket and/or
recorded in the real property records of Lane County, Oregon to serve as notice to any future owners of the Property.
This agreement requires the original signature of all owners. Each signatory to this agreement thereby SWEARS, AFFIRMS, AND WARRANTS to
the City of Veneta, under penalty of perjury, that she (he) is either the owner of the property or is empowered by a valid legal authorization to
execute this agreement on behalf of the Owner. The Signatory agrees to reimburse City for any expense incurred as the result of a false
statement as to ownership or authority and understand that it is a violation of State law to make a false statement.
Owner's Signature:
I/We understand that the City requires a completed application prior to providing services and that if we have a property management
company managing our properties, I/we authorize the property management company, listed above, to complete the owner's section
of each non-owner residents or occupants applications on our behalf.
I/We understand that the City requires a completed application prior to providing services and that if we do not have a property
managment company I/we do not authorize the property manangement company to complete the owner's section of each non-owner
residnets or occupants applications on our behalf. I/we will complete and sign the owner's section myself/ourselves.
Check (e) or (f):
Agreement complete
Agreement signed
Agreement attached to owner account(s)
Agreement scanned
FOR CITY USE ONLY
S:\FORMS\Utility Billing\Property Owner Agreement.xlsx 3/12/2020
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Instructions: 1. Complete this agreement in its entirety (City of Veneta)

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Completed 17 July 2020

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