I/We hereby make application for service at the premises as stated.

I acknowledge a copy of the MCMA Rates and Rules can be obtained at https://mifflincountyh2o.com/.

I acknowledge active / water available accounts are billed the current minimum charge for zero consumption.

The undersigned agrees to make payments for all water, sewer and/or refuse service furnished or rendered in accordance with the applicable schedule of rates and agrees to conform to the rules and regulations adopted by the designated Authority. The Authority of the Borough of Lewistown shall have the right to terminate this contract by giving thirty (30) days written notice to the undersigned.

I certify under criminal penalties prescribed by section 4904 of the PA "Crime Code" for making false statements to a public official or body, that I am the owner of the referenced property and as such that it is recorded on the deed at the Mifflin County Courthouse, and I may be subject to fines and penalties for false statements.