2. I am the owner of the property listed below and have agreed to have a meter reading encoder installed at:
   (Address, city, state, zip)
4. The cost is $65 per meter. This amount will be charged to my Water/Utility account after the encoder is installed by the City’s private contractor. I also understand that the encoder equipment is the property of the City of Dayton.
6. Signed
7. Date
   Date
9. Daytime Phone Number
11. Fill out and return to:
    City of Dayton
    Division of Revenue and Taxation, Billing
    101 W 3rd Street
    Dayton, OH 45402
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12. Print Only

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