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2. NOTICE

4. Request for Disclosure of Information Maintained by the City of Fate Utilities Department

6. Information in your City of Fate Utilities Department customer account record, including information regarding customer usage, services, and billing, including amounts billed or collected for utility usage, is generally excepted from disclosure under Texas Government Code, Chapter 552 (Public Information Act).* However, the Texas Utilities Code, Chapter 182 (Rights of Utilities Customers) provides that a customer of a government-operated utility may request that the government-operated utility disclose personal information in a customer’s account record, including the customer’s address, or any information relating to the volume or units of utility usage or the amounts billed to or collected from the individual for utility usage. Additionally, a customer or a representative of the customer may receive information excepted from disclosure if the information directly relates to utility service provided to the customer and is not otherwise confidential by law.

    

   This form enables you to request disclosure of certain information under Texas Utilities Code, Chapter 182. If you wish to request disclosure of your information, please check the boxes below and return this form. If you do not want your information disclosed, you do not need to complete this form.

8. Release of Information:
10. Customer Name:
11. Account Number:
13. I authorize the City of Fate Utilities Department to disclose:

    1. my personal information and/or
    2. information regarding my usage, services and billing, including amounts billed or collected for utility usage to:
15. Name:
16. Address:
17. Driver's License No:
19. I authorize the City of Fate Utilities Department to release my account information to the public upon written request by any member of the public.
    -- Select One --YesNo

21. You may rescind your request for disclosure by providing the City of Fate Utilities Department written notice. A government-operated utility or an officer or employee of a government-operated utility is immune from civil liability for a violation of Texas Utilities Code, Chapter 182, Subchapter B.

     

    • Confidentiality under Chapter 182 does not prohibit a government-operated utility from disclosing personal information in a customer's account record to: (1) an official or employee of the state, a political subdivision of the state, or the United States acting in an official capacity; (2) an employee of a utility acting in connection with the employee's duties; (3) a consumer reporting agency; (4) a contractor or subcontractor approved by and providing services to the utility, the state, a political subdivision of the state, or the United States; (5) a person for whom the customer has contractually waived confidentiality for personal information; or (6) another entity that provides water, wastewater, sewer, gas, garbage, electricity, or drainage service for compensation.
23. Customer Signature
24. Date
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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