2. City of Creston
   City Hall Phone: 641-782-2000
4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip
13. Phone Number
15. Address to Suspend Service
    (if different from contact address)
17. City
18. State
19. Zip
21. Reason to Suspend Service
23. Inclusive Dates
    Inclusive Dates Start Date

    —

    Inclusive Dates End Date
    Suspend service from date - to date
25. The City may, at its discretion, grant a temporary suspension of service to residents for temporary absence of residence. Temporary suspensions will be granted for no less than 2 continuous months. Temporary Suspension of service and payment will be given for full months only, beginning with the first day of any designated month through the last day of the following month. The City will administer and monitor all Temporary Suspension grants, and will communicate any suspensions to the Contractor (Waste Management) no later than the 24th day of each month. Waste Management will adjust the monthly billing to accommodate all approved Temporary Suspensions.
27. I agree to all the above conditions and will promptly report to the Creston City Waterworks if conditions change and a return to service is required.*
    E-Signature of Applicant
28. Date
    Date
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

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