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Extended Leave Form

  1. Extended Leave - Billing Request
  2. Services to be Discontinued:
  3. Sewer and Garbage:

    Check all that apply

  4. Authorization

    I authorize that this information is correct and will be billed accordingly. Dates will not be adjusted without proper notification beforehand to City personnel. 

  6. Leave This Blank:

  7. This field is not part of the form submission.