Form W-120A is a form used to report the sale of assets by a taxpayer. The form is used to report the proceeds from the sale, as well as any related expenses. The form must be filed within 30 days of the sale, and can be used to report either individual or business assets. The form is relatively simple to complete, and can be filed electronically.
Question | Answer |
---|---|
Form Name | Form W 120A |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | ApplicationForS ervice mawc application form |
SERVICE NO: ________________ |
Municipal Authority of Westmoreland County |
DATE: ______________________ |
ACCOUNT NO: ____________________ |
Application for Water |
and/or Sewer
Service |
USER __________________ S02 |
I,, request that water service be Initiated at the following location:
Street/Lot/Plan__________________________________________________________ City_______________________________ ZIP _____________
Tax Map Number _______________________________________________________ County ____________________________________________
SERVICE MAY BE EXTENDED TEMPORARILY UNTIL VERIFICATION WITH THE OWNER/LANDLORD IS RECEIVED.
I am the OWNER / TENANT (circle one) of the property listed above. I agree to use the water according to the rules and regulations of the Authority, copies of which are available for public inspection at the Authority Office, and to pay for water service at the above location in accordance with the rules and rates approved by the Municipal Authority of Westmoreland County within fifteen (15) days from the date that I receive the bill.
I further agree that I will complete the information called for within this application. I understand that I may be required to post a security deposit. In the event that I am required to post a security deposit, the amount will be determined by the Municipal Authority to secure the utility from loss. The amount of any security deposit I may be required to post will be refunded in accordance with the rules and regulations of the Municipal Authority of Westmoreland County.
Type of Service
Existing Service
Building Type
Single Family Dwelling
New Construction
Duplex |
Apartment |
Class of Service
Residential
Retail |
Other |
Commercial |
Industrial |
If other, describe: |
_________________________ |
Sanitary Sewer Service |
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Public |
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Are you a new customer? |
Yes |
If public, list Sewer Authority ________________________________________________
No
If No, previous service address:________________________________________________________ City____________________________________
Applicant Information:
Main phone number: ( _______ ) _______ - ________________Cell phone number: ( _______ ) _______ - ____________________
Employer: _______________________________________________________ Work phone number: : ( _______ ) _______ - __________________
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Social Security Number: ________ - _______ - ________ |
Authorized Contact Person __________________________________________ |
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Drivers License # ______________________________ State ____ |
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Spouse Information |
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Name: |
______________________________________________________ Employer: |
__________________________________________________ |
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Work phone number: (______ ) _______ - __________________ |
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In case of Emergency, contact: |
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Name: |
______________________________________________________ |
Phone Number: ( ______ ) _______ - __________________ |
Address: _________________________________________________ City:____________________________ST: _______ Zip:__________________
Complete billing address if different from service address:
Street:_______________________________________________________ City: ____________________________ ST:_______ Zip: _____________
If TENANT, complete landlord information requested below:
Name: _____________________________________________________ Street: _______________________________________________________
City:____________________________________ State: ___________ Zip: _____________ Phone Number: ( _______ ) ________ - ___________
I represent that the above location is presently capable of accepting water service. I understand that this application is accepted subject to the availability of water at this location.
Applicant’s Signature: X____________________________________________________________ Date: ____________________________
Deposit
Comments/Additional Information: __________________________________________________________________________________________
Documentation Attached: |
Lease |
Personal ID
(rev. 03/29/07) |