HomeMy WebLinkAboutRelease of Information FormTROPHY CLUB MUNICIPAL UTILITY DISTRICT No. 1
Customer Release of Information Authorization Form
Information in your Trophy Club Municipal Utility District No. 1 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.
Release of Information:
Customer Name: Account Number:
❑ I authorize Trophy Club Municipal Utility District No. 1 to disclose:
Limy personal information and/or
❑ information regarding my usage, services, and billing, including amounts billed or collected for utility usage
to:
Name:
Address:
Phone No.:
❑ I authorize Trophy Club Municipal Utility District No. 1 to release my account information to the public upon
written request by any member of the public.
You may rescind your request for disclosure by Trophy Club Municipal Utility District No. 1 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.
Signature of Account Holder: Date:
TCMUD1 1 Utility Billing