P.O. Box 487 - 757 2nd Street (308) 874-2401
Chappell, Nebraska 69129 Fax (308) 874-2508

BUDGET BILLING - UTILITIES

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Date

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Property Address

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Monthly Billing Amount (average of Prior 12 months)

Comments

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Signature

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City Use Only

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Budget Amount - - - - - - - - - - - - Start Date

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Date put in System