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Deceased Account Handling Application Form - MA Gas

* indicates required fields
Please complete the following information regarding the Deceased Account Holder:
Please complete the following information regarding yourself:
Please check the applicable option below and follow the instructions depending on what action you are requesting. Submit this completed form along with the required documents.  Requests will not be processed until all required documents are received. Partial documentation will not be sufficient to complete the necessary action requested.
Close the account and turn off service
NOTE: By requesting this option, you attest that you have authorization to make this request and disconnecting the gas service will not adversely impact another person who may be benefiting from the service.

1) Please Attach Photo Proof for the following item. (Note: Photo images will be accepted).
2) In addition, please provide a Name and Address to where the Final Bill should be sent.
123 East Main St, Anytown, NY 12345

IMPORTANT! - Please be aware a DISCONNECT request cannot be issued until a copy of the Death Certificate is received.

Gas Service Be Placed In The Name of The Estate
Please send in completed copies of the documents listed below:
Please provide a Name and Address to where the Final Bill should be sent.
123 East Main St, Anytown, NY 12345

NOTE! - Powers of Attorney and Last Will and Testaments are NOT sufficient documentation when the account holder is deceased.

Remove Account From Direct Pay/EFT

NOTE: Depending on the date of the scheduled withdrawal or if the funds are in “pending” status, we cannot guarantee that the funds will not be withdrawn.