Change of Ownership Wisconsin Standard Distributed Generation Application Form

	EFFECTIVE DATE FOR CHANGE OF OWNERSHIP
	MM/DD/YYYY

	This is to confirm that the new owner listed below has acquired from the listed below the [facility type - select] generating facility located at the address below, as of the effective date listed above.
	Previous Owner
	New Owner
	Address	City	State	Zip

	FACILTY TYPE
	Solar Photovoltaic Wind Turbine Generator Energy Storage System
	Pursuant to the applicable Distributed Generation Interconnection Agreement this is to confirm that the New Owner assumes the duties, obligations, and liabilities of the Previous Owner under the Agreement and agrees to discharge and perform such duties, obligations, and liabilities. New owner shall include proof of insurance as described in the PSC 6031 form along with this form.
	Proof Of Insurance Insurance Attachment Filename

	The new owner consents to the assignment and assumption of the Agreement by signing below and returning a signed copy of this letter to the electric provider
	New Owner Signature		Owner Signature Date
	Owner Print Name		Owner Title
	Owner Email		Owner Phone

	ELECTRIC PROVIDER hereby consents to the assignment of the Agreement by the Previous Owner to the New Owner listed here.
	PLYMOUTH UTILITIES Electric Provider
	Signature		Signature Date
	Ryan T. Roehrborn Print Name		Operations Manager Title
Change of Ownership \| Wisconsin Standard Distributed Generation Application Form (Effective 5/1/2024) Page 1
2/15/2026 0 0 0 0

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