Port Richey’s utility adjustment form asks for more than an account number and a disputed total. It distinguishes landscaping, water and irrigation leaks, service charges, late fees, deposits and other requests. For certain repairs, it also requires a notarized affidavit—not just a receipt. City form

Prepare the customer portion

Download the current PDF from the City’s adjustment page. Use this preparation checklist alongside it:

  • Match the account and bill. Enter the account number, service address and customer contact information. The customer-statement area asks for the bill date; identify the entry you want reviewed rather than referring only to “the high bill.”
  • Describe the work where relevant. The form asks when work occurred, who performed it and whether installation was by the owner, a professional or a tenant.
  • Check the attachments. It has separate yes/no fields for photos and a receipt. Mark what is actually included; a photo indicator is not evidence that Billing received the file.
  • Complete the statement and signature fields. Explain the request in the customer area. Leave the credit, debit and billing-technician fields for Billing.

The form supplies the fields; the checklist above is LSL’s way to reconcile them before submission. Keep account details and attachments private, not in public comments. Form fields

When the repair affidavit applies

The form says repairs performed by someone other than a licensed plumber or contractor require a notarized repair affidavit stating when and where the leak was repaired. It also calls for dated, paid receipts for necessary parts. An owner-completed repair should not be presented as professional installation to bypass that instruction. Repair instruction

That note is about repairs. It does not establish that every late-fee, deposit or landscaping request needs the same affidavit. Ask Billing which documentation applies if the request does not fit the repair wording.

Confirm the return channel and decision

The form lists ub@cityofportrichey.com and 727-816-1900. The Utilities Department confirms the telephone number and 6333 Ridge Road address.

Before returning sensitive documents, ask Billing how it wants the complete package delivered, whether a deadline applies and what acknowledgment to expect. The reviewed form does not publish one universal filing deadline or credit formula. A category checkbox is not a promise of eligibility, and the staff-only adjustment area is not yours to calculate. Billing contact and decision fields

What we checked

LSL followed the City’s navigation to the maintained form page and visually read the one-page scanned PDF on September 13, 2026. We compared its fields with the department contact and built the preparation checklist. We did not submit a request or inspect a customer account.