Application for Utility Service

Income Tax Information:

The above information will be used by the Village of Haskins Tax Department to add your name to the Village tax rolls. All residents of the Village must file a tax return whether the tax is withheld or not, and whether he or she has taxable income or not. The income tax rate is 1% with a credit of 1/2% for withholding by another city or village.

By Submitting this Form, You Agree to the Following:

I certify the above information is complete and true to the best of my knowledge. I understand if any. utility bill is unpaid by the time of the next utility billing, it shall be considered delinquent and procedure for shutoff of the utility services will be instituted 15 days after the account is first delinquent. Once utility services have been discontinued, they shall not be reinstated until the account is paid in full including any disconnection and reconnection fees. In consideration for the furnishing of utility services to the property for which application is made, the undersigned accepts responsibility for the payment of all utilities furnished.