Recreation Pass Extension/Cancellation/Change Request Form

Last Name:
Household Members Affected by Change or Cancellation:
Address:
Phone Number:
Email Address:
Current Status: Resident NR Employee Non Res Senior Low Income Disabled
Current Pass Type: Annual Annual (Matinee) Recreation Pass Recreation Pass (Matinee) Single Month

Type of Request (Must be made 30 days in advance of billing date)

• An email confirmation will be sent to verify that the cancellation request has been received and processed. Please call 248.619.7677 if you have any questions.
• The City of Troy reserves the right to refuse a request for cancellation if a balance exists on the household's account.

The City of Troy reserves the right to refuse any request for cancellation.