TO: FLINT CITY COUNCIL

WATERAFFIDAVIT DATEFILED:

CLERK:

TO:FLINTCITYCOUNCIL

Thisaffidavitisfiledpursuanttochapter46oftheFlintCityCode,1939PA178and198, PA

132,(MSA5.2531et.Seq.)and133PA(MSA5.2751)tonotifycouncilofatenants

responsibilityforthepaymentofchargesforwaterandsewagedisposalservices,andtoprevent

delinquent chargesforsaidservicesfro mbecominga lienuponsaidpremises.

STATEOFMICHGAN))SS.

COUNTYOFGENESEE) __________________________, first beingdulysworn,deposesandsays:

1. Thathe/sheisthepropertyownerofrecordofthepremiseslocatedat:

___________________________________________, Flint,Michigan

Thathe/sheistheagentfor_________________________,whoisthepropertyownerof

recordforthepremiseslocatedat:

___________________________________________, Flint,Michigan

PERMANENTPARCELNUMBER_______________:RENTALLICENSENUMBER______________:

EXPIRATIONDATEOFLICENSE____/____/____.

AVALIDRENTALLICENSEMUSTBEONFILEWITHTHEBUILDINGINSPECTIONSDEPARTMENT.

2. Thatthepremisesareleasedto________________________,whohas/haveagr eedinalegally

executedleasetoberesponsibleforthepaymentofwaterandsewersystembillsaccruing

subsequenttothetothefilingofthisaffidavit.

3. Theleasedoesdoesnothaveanexpirationdateof_______________.TWENTY(20)

DAYSWRITTENNOTICESHALLBEGIVENBYTHELESSOROFANY

CANCELLATION,CHANGEIN,ORTERMINATIONOFTHELEASE. Thefilingofa

subsequentaffidavitandleasewithinthe20dayperiodshallbesufficientnotice.Failurebythe

lessortonotifythisofficein writingwillresultinterminationoftheaffidavit. 

THISAFFIDAVITWILLNOTBEACCEPTEDWITHOUTACOPY OFTHESIGNEDLEASEOR

RENTALAGREEMENTATTACHEDANDMUSTHAVEBEENNOTARIZEDWITH INTHEPAST30

DAYS.

SIGNATUREOFOWNER/AGENT(COPYOF PAPERSATTACHED) _______________________________________________________

ADDRESSOFOWNER/AGENT– PROPERRETURNADDRESS_______________________________________________________________

CITY,STATE,ZIP:_______________________________PHONENUMBER___________________________

SUBSCRIBEDANDSWORNTOBEFOREMETHIS_______DAYOF______________20______A.D.

________________________________________

NOTARYPUBLIC,GENESEECOUNTY,MI.MYCOMMISSIONEXPIRES:

IREQUESTTHATTHEWATERANDSEWERSERVICEBEPLACEDINMYNAMEATTHEABOVE

LISTEDADDRESS:

IDECLAREUNDERPENALTYOFPERJURYTHATTHEINFORMATIONONTHIS

FORMISTRUEANDCOMPLETE,ANDALLSIGNATURESAREAUTHENTIC.

______________________________________ DriversLicense/MichiganI.D._____________________________

tenantname(s)

TENANTSOCIALSECURITYNUMBER__________________________EXPIRATIONDATEONI.D._____________________________

AUTHORIZINGSIGNATURE:______ _____________________________DATEOFBIRTH____/____/____PHONE___________________

Revised07/28/2 011

LandlordTenantAgreement(Lease)

LANDLORD(S):_________ _____________________________ _______

ADDRESS: ____________________ ________________,MI48__ ___

ALLTENANTSNAMESATTHISLOCATION:

____________________ _________________________ ________________

AddressofPropertyRented: ____________________ ________,MI48_____

RENTALPERIOD

_____MONTHLY _____BIWEEKLY _____WEEKLY

OTHER_________

RENT: $________________

RENTISDUEONTHE______________DAYOFTHERENTALPERIOD

TENANTISresponsibleforallchargesforwaterandsewerservicewhilerentingthis

property.

TENANTWILLputwaterandsewerbillsinitsname.

NOTICE:MICHIGANLAWESTABLISHESRIGHT SANDOBLIGATIONSFORPARTIESTORENTAL

AGREEMENTS. THISAGREEMENTISREQUIREDTOCOMPLYWITHTHETRUTHINRENTINGACT .IFYOU

HAVEAQUESTIONABOUTTHEINTERPRETATIONORLEGALITYOFAPROVISIONOFTHISAGREEMENT,

YOUMAYWANTTOSEEKASSISTANCEFROMALAWYEROROTHERQUALIFIEDPERSON.

LANDLORD'SSIGNATURE: TENANT'SSIGNATURE:

____________________________________ ________________________________

________________________________________________________________

SIGNED___________________,20____ SIGNED_______________,20____

WTR9(REV.1/07)