2. City of Wayne
   Water Account Name Change Form

4. Property Address:*
6. Water Account Number:

10. Change Name To:

12. Type:

    1. Owner
    2. Tenant
14. First Name*
15. Last Name*
17. Daytime Phone Number:*
19. Email Address
21. Requester Name:*
25. Reason For Request:*

    1. Occupant Name Change (water only - no transfer of property)
    2. No longer principal residence (must complete rescind form)
    3. Property Owner Name Change (must complete property transfer affidavit)
    4. Other (specify below)
27. If checked 'Other' for request reason:
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field