Form Center

2. 
4. This form is to be used by any resident that is moving out of their current place of occupancy. Please fill out form completely and print a copy and bring to the Village Hall with a copy of your photo ID.

   Please Note: An appointment will be made to have a final reading and to turn water off. Please indicated that as your move out date.

6. Move Out Date*
   Move Out Date
7. Richton Park Service Address*
9. First Name*
10. Last Name*
11. Phone Number*
13. Forwarding Address
15. Address*
16. City, State*
17. Zip*
21. If Sold, or Tenant / Renter*
    -- Select One --SoldTenant / Renter
22. First Name*
23. Last Name*
25. Address
26. City, State
27. Zip
31. Electronic Signature Authorized

    1. Yes
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field