K-4 - One-time Water and Sewer Adjustment at 99 Brown Street

P.O. BOX 259 TIFFIN, IA 52340 (319) 545-2572 KEVIN WILSON PO BOX 421 99 BROWN ST TIFFIN, IA 52340 <table> <tr> <th>Account Number</th> <th>AMOUNT DUE</th> </tr> <tr> <td>01-01000480-00</td> <td>$375.32</td> </tr> <tr> <th>Due Date</th> <th>After Due Date Pay</th> </tr> <tr> <td>3/20/2022</td> <td>PAID BY DRAFT</td> </tr> <tr> <th colspan="2">Account Name</th> </tr> <tr> <td colspan="2">KEVIN WILSON</td> </tr> <tr> <th colspan="2">Service Address</th> </tr> <tr> <td colspan="2">99 BROWN ST</td> </tr> <tr> <th colspan="2">Amount Enclosed</th> </tr> </table> There will be a charge on all returned checks. Please return this portion with your payment. When paying in person, please bring both portions of this bill. CUSTOMER ACCOUNT INFORMATION - RETAIN FOR YOUR RECORDS <table> <tr> <th rowspan="2">Name</th> <th colspan="3">Service Address</th> <th colspan="2">Account Number</th> </tr> <tr> <td colspan="3">KEVIN WILSON<br>99 BROWN ST</td> <td colspan="2">01-01000480-00</td> </tr> <tr> <th>Status</th> <th>Service Dates From</th> <th>To</th> <th># Days</th> <th>Bill Date</th> <th>Penalty Date</th> <th>Due Date</th> </tr> <tr> <td>Active</td> <td>1/14/2022</td> <td>2/15/2022</td> <td>32</td> <td>2/28/2022</td> <td>3/21/2022</td> <td>3/20/2022</td> </tr> </table> Usage CURRENT READING 4,672 PREVIOUS READING 1,587 USAGE 30,850 <table> <tr> <th></th> <th></th> <th></th> </tr> <tr> <td>PREVIOUS BALANCE</td> <td>$134.52</td> <td></td> </tr> <tr> <td>PAYMENTS</td> <td>$134.52-</td> <td></td> </tr> <tr> <td>ADJUSTMENTS</td> <td>$0.00</td> <td></td> </tr> <tr> <td>PENALTIES</td> <td>$0.00</td> <td></td> </tr> <tr> <th>PAST DUE AMOUNT</th> <th>$0.00</th> <th></th> </tr> <tr> <td>WATER</td> <td>176.68</td> <td></td> </tr> <tr> <td>SEWER</td> <td>166.04</td> <td></td> </tr> <tr> <td>GARBAGE</td> <td>13.50</td> <td></td> </tr> <tr> <td>STORM WATER</td> <td>3.00</td> <td></td> </tr> <tr> <td>RECYCLING</td> <td>5.50</td> <td></td> </tr> <tr> <td>Tax</td> <td>$10.60</td> <td></td> </tr> <tr> <th>CURRENT BILL</th> <th>$375.32</th> <th></th> </tr> <tr> <th>AMOUNT DUE</th> <th>$375.32</th> <th></th> </tr> <tr> <th colspan="2">PAID BY DRAFT</th> <th></th> </tr> </table>