2. 

3. Owner's Authorization
   to send COPY 
   of Utility Bill 
   to Tenant

5. Yes, we can send a COPY of the Utility Bill to Tenants

   Upon completion of this form, the Town of Diamond Valley will send a copy of the Town utility (water, sewer, waste services) bill to tenant(s) authorized by the owner(s) of the property.  

   The purpose of sending the duplicate bill is to serve notification to the tenant(s) of the cost of utilities services.   

   The tenant(s) will receive a copy of the utility bill and the property owner(s) will continue to receive the original.  

   The property owner(s) are solely responsible for any amount owing, including any fees that are applied as penalties above the regular utility billing.   

   Any utility amounts outstanding as of December 15 of any calendar year will be transferred to the property owner(s) tax account in accordance with the Municipal Government Act.  Tax amounts owing at December 31 are subject to a 12% penalty in accordance with the Imposition of Tax Penalties Bylaw. 

7.   Property OWNER Information

9. Name*
11. Residential (Physical / Civic) Address*
12. Roll Number (if unknown, please leave blank)
14. Primary Phone Number*
15. Alternate Phone Number
17. Mailing Address*
18. Town*
19. Postal Code*
21. Email address*

23.   Renter / TENANT Information

25. Start Date / Move-In Date*
27. Name(s)*
29. Email Utility Bill*

    Would the Tenant like a COPY of the Utility bill sent to them by email as opposed to postal mail? 
    
    Note: A $2 bill charge applies to the account for all printed bills.  If "No" is selected, a $2 paper bill charge will apply.

    1. Yes
    2. No
31. Email Address
33. Primary Phone Number
34. Alternate Phone Number
36. Mailing Address

    If unknown, please leave blank and update us as soon as the post office box number is known.

37. Town / City
38. Postal Code

40.   Authorization & Agreement 

42. Authorization Agreement

    I authorize the Town of Diamond Valley to direct a COPY of the property's Utility Bills to my tenant at their mailing or email address provided above. 

    I understand that I am ultimately responsible to ensure the utility bills are paid; and that unpaid amounts may be penalized and added to the tax account for the property.

44. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
46. Electronic Signature*
47. Date Signed*
49. Personal Information

    The personal information collected through the Owner's Authorization to send COPY of Utility BIll to Tenant form is for the purpose of obtaining the permission of the property owner to send a duplicated copy of the utility bill to a tenant or alternate person. This collection is authorized under section 4(c) of the Protection of Privacy Act. For questions about the collection of personal information, contact the Privacy Office LegislativeServices@DiamondValley.town or 403-933-4348

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field