Work Sheet
Michael C. Sample Account Number: 1234567890t
Billing Date: 7/19/14 Due Date: 8/9/14
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City of Anytown City Services Bill
The 2016 Anytown Water Quality Report is available online at Anytown. gov/waterqualityreport.
If your curbside trash or recycling container is broken complete our online form at Anytown.gov/publicworks or call 602-999-1234 to request a new one.
City Services Statement as of 7/21/2015
Previous Balance $59.94 Payments Recieved - Thank You -59.94 Balance Forward 0.00 Current Charges 68.09
Total Amount Due $68.09
Unpaid Balance $0.00
Current Charges Due 8/9/2014 68.09
TOTAL DUE $68.09
Service Address: 1234 ANYSTREET RD. PHOENIX, AZ 85000 Meter
Number Previous Meter Read Current Meter Read Water Used in
Billing CycleDate Reading Date Reading
12345678 6/18/2014 1749 7/19/2014 1761 12 Units 8976 Gallons
1 unit = 745 gallons
10,000- 8,000- 6,000- 4,000- 2,000-
JUL AUG SEPT OCT NOV DEC JAN FEB MAR APR MAY JUN
Your Monthly Water Usage (gallons)
Please detach and return the portion below with your payment
nLast Year oCurrent Year
Water/Sewer Service from 6/18/2014 to 7/19/2014 Water Base Fee $4.36 Water Usage Fee 7.54 Environmental Mandates - Water 4.56 City Services Tax 1.50 Sewer Fee 15.89 Environmental Mandates - Sewer 3.62 State Mandated Jail Costs 1.00 City Sales Tax 0.97 State and Other Taxes 1.80
Subtotal $41.24 Solid Waste Service from 6/18/2014 to 7/19/2014 Refuse $26.80 State Landfill Disposal Fee 0.05
Subtotal $26.85
Water/Sewer Services: (602) 252-6251 Solid Waste: (602) 262-7251 TDD: (602) 534-1113 To Pay Online: www.anytown.gov
CITY OF ANYTOWN PAYMENT INSTRUCTIONS Please make checks payable to City of Anytown. Do not send cash through the mail. Please write account number on check.
A Late Fee will be applied if payment is received after the Due Date.
Account Number: 1234567890
Amount Paid
$ Project Assist Donation $ ___________
SN 0020130128 RT# 000001075 AN 91234567890000 TC 039100
002013012891234567890000120910030000006809000000000000000000000000000000000
Sample, Michael C. 1234 W. ANYSTREET RD. ANYTOWN, AZ 85000-123456
SEND PAYMENTS TO: City of Anytown P.O. Box 29100 Anytown, AZ 85038-9100