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Request to Remove/Add Name to Membership
Date
Member Name
Account
Email
I want to
- Select -
Remove a Name
Add a Name
Request to Remove Name from Membership
Reason for Membership Conversion
Dissolution of Marriage
Legal Conclusion of Partnership
Legal Separation
Marriage, but No Longer Reside in Same Location
Requested changes may require additional legal documentation. Any changes made to Membership are subject to Sierra Electric Cooperative, Inc. Bylaws. A copy of the Bylaws can be provided upon request.
Named to be Removed
Name to be Removed
Removed name understanding
I understand that removing my name from this account, I will no longer have the ability to make changes or access any information on the membership listed above. I understand that removing my name does not relieve me, my estate, personal representative and heirs, from any debts due the Cooperative prior to the date of this form. I understand that the interest of any patronage capital belonging to the joint membership will be passed to and recorded in the name of the remaining membership holder.
Signature of Removed
Signature (Name to Be Removed)
Remaining Member
Remaining Member
Remaining Member understanding
I agree to the conversion of the above listed joint membership into a single membership in my name only. I understand that I will solely be responsible for any debts due the Cooperative from the date of this form forward.
Signature of Remaining Member
Signature (Name of Remaining Member)
Request to Add Name to Membership
Reason for Membership Conversion
Marriage
Legal Partnership
Requested changes may require additional legal documentation. Any changes made to Membership are subject to Sierra Electric Cooperative, Inc. Bylaws. A copy of the Bylaws can be provided upon request.
Name to be Added
Adding name understanding
I understand that by adding the name to the account, It will share jointly the membership listed above and agree to abide by the terms of membership
Signature of Name to be Added
Signature (Name to be Added)
Signature of Original Member
Signature (Name of Original Member)
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