Release Authorization for Utility Bill Histories

RELEASE AUTHORIZATION FOR UTILITY BILL HISTORIES

Apartment Community Name: Resident Name(s): Mailing Address:

Property: Apt #: Date:

I/we live at the Apartment Community listed above. I/We hereby give my/our permission for the utility company(ies) listed below to whom I/we pay utility fees, to release consumption/usage data on my/our account.

This information is necessary in order for Management to determine whether the utility allowance given by program requirements is adequate. I/We have provided Management with the information listed below for this purpose.

Apt #: Account Holder's Name(s):

Account Holder's Mailing Address: Zip:

Electric Gas

Account Number

Name of Utility Company

Utility's Mailing Address

City, State, Zip Code

Dear Utility Company,

Please provide the most current past 12-month history of consumption/usage for my/our apartment. Be sure to list the usage and charges separately for each billing period.

Please mail this information to the apartment community's address shown above.

Sincerely,

Account Holder's Signature(s): Date:

Thank you for your assistance in this matter.

Utility Release Authorization (4/04) Page 1 of 1 RA-24hrt