This form is to be used by new Homeowners of the Village of Richton Park. Please fill out form completely and print a copy and bring to the Village Hall with the following documents: Settlement Statement, Copy of Photo ID, Occupancy Inspection, and $50 Water-Application Fee. Please Note: An appointment will need to be made in order to turn water on and someone must be present at the service address at the time of the appointment.

Move In/Close Date:*

First Name: *

Last Name: *

Richton Park Service Address: *

Home Phone #:

Cell Phone #: *

Social Security #: *

Date of Birth: *

Provide at least last 4 digits

Employer's Information:

Employer's Name: *

Address:

City:

State:

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Zip:

Work #:

Signature: Must present photo ID in person

If you would like, you may upload your settlement statement and occupancy inspection to help save time.

Settlement Statement:

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Occupancy Inspection:

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