Request for Disclosure of Information Maintained by the City of Mineola Utility Department

Information in your City of Mineola Utility Water 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 the Texas Government Code, Chapter 552 (Public Information Act). *However, the Texas Utilities Code, Chapter 182 (Rights of Utility 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 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 the Texas Utilities Code, Chapter 182. If you wish to request disclosure of your information, please check the boxes below and submit this form.

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Account Information

First Name *

Last Name *

Email *

Account Number

Service Address

No. *

ex: 300

Street Name *

ex: Broad (no odonym's such as st. ave. rd. ct.)

Suite/Apt. No

Release of Information

I authorize the City of Mineola to disclose my personal information to:

I authorize the City of Mineola Utility Department to disclose information regarding my usage, service and billing, including amounts billed or collected for utility usage to:

I authorize the City of Mineola Utility Department to release my account information to the public upon written request by any member of the public

Releasable To:

First Name

Last Name

DL Number

Address

Disclosure

You may rescind your request for disclosure by providing the City of Mineola Utilities Department 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 the 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 services for compensation.

Authorization

Signature *

Date *

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Request for Disclosure of Information Maintained by the City of Mineola Utility Department

Contact Information