Transfer-Form1, PDF - Black Rock Water Supply

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Transfer-Form1, PDF - Black Rock Water Supply
5315 Hwy 377 S.
Krugerville, TX 76227
(940) 365-0963
www.blackrockwater.com
To: Black Rock Water Supply Corporation
P.O. Box 430
Aubrey, Texas 76227
After paying all indebtedness to the Corporation and receiving the approval of Black
Rock WSC, I hereby assign and transfer unto
_______________________________________ this membership and do authorize the
Secretary of the Corporation to reflect this transfer on the books of the Corporation. This
transfer is to become effective on ________________________________, _________.
Dated this the ______ day of _______________________,______
____________________________________ ___________ ___________
Member Signature
Member #
Account #
____________________________________________________________
Approved by:
STATE OF TEXAS
§
COUNTY OF DENTON §
BEFORE ME, a Notary Public for the State of Texas, appeared
___________________________________________________________, known to me
to be the person represented in the above instrument.
Dated this the _______ day of ______________________________,________
__________________________________________
Notary Public
Property address:______________________________________________________
New owner’s mailing address:____________________________________________
Please return this form and $25.00 transfer fee to: Black Rock Water Supply Corporation.
Safe Water…a Basic Requirement of Life

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