2. CITY OF BLYTHE
   UTILITY DEPARTMENT
   MONTHLY VACANCY REPORT
   235 N BROADWAY BLYTHE, CA 92225
   760-922-6161 EXT 1233 or 1234
4. 
   MUST BE SUBMITTED NO LATER THAN THE 20TH OF THE MONTH
   
   
6. Account Name:*
7. Account #:*
9. Total:
10. Occupied:
11. Vacant:
13. A signature is required to process your request. By entering your valid email address in the box below you are signing this form and confirming that the above information is correct.*
14. 
    
    Date:*
    
    
    Date:
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