Action Center / Water & Sewer Termination of Service Form / Village of Lindenhurst

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Water & Sewer Termination of Service Form

2301 East Sand Lake Road
Lindenhurst, IL 60046
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Moving out the Village of Lindenhurst? Please fill out this form to end service at your Lindenhurst address.

* Denotes a required field

Please Do Not Complete The Following Field

Closing Date/Renter Move Out Date*

MonthDay Year,

Address 1*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

First Name*

Last Name*

Status*

Closing Date

Renter Moving Out

Owner Renting

Address/Name Change update

Telephone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

Email Address*

Address 1

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.