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<br />FEB-22-2005 12:35 <br /> <br />CENTERPOI NT M I NNEGASCO <br /> <br />612 321 4806 <br /> <br />P.02 <br /> <br />AUTHORIZATION TO DISCONNECT GAS SERVICE <br /> <br />I authorize CenterPoint Energy to lock the gas meter(s) at my rental property listed below. <br /> <br />Rental Property Street Address <br /> <br />Rental Property City, State and Zip Code <br /> <br />Rental Property Meter Number <br /> <br />. <br /> <br />1 agree to provide CenterPoint Energy access to my rental property so that the meter(sj can be <br />locked. Centerpoint Energy will notify me if access cannot be gained. . <br /> <br />r agree that 1 am tcsponsible for any loss or damage that results from lack ofhcat. <br /> <br />To resume gas service, I agree to notify CenterPoint Energy. lfreconnection ifbeing 40ne in my <br />name or my company name, I agree to pay a reconnection fee. <br /> <br />Name <br /> <br />Mailing Address <br />., <br /> <br />Business relephone <br />, <br /> <br />Signature' <br /> <br />Date <br /> <br />CenterPoint Energy Representative <br /> <br />',. <br />