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Reduced Utility Rate Application Form
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Application for Special Utility Rates and Services
This form is used to evaluate requests for special utility service rates for low income senior citizens or disabled residents and for special non-curbside garbage pickups for customers whose physical conditions make it difficult for them to place the garbage container at the curbside location. Low income senior citizens and low income handicapped residents of the City may apply to receive water and sewer services at one quarter of the monthly minimum charge.
Water/Sewer Rate for Qualified Customers Water and sewer utility rates will apply to those qualified customers who utilize a 5/8-inch single family residential service. Customers requiring service in excess of a 5/8-inch single family residential service shall not qualify for a rate reduction regardless of income.
Please use the following definitions in determining eligibility:
(1) Low-Income: A household in which the total annual income is below the very low income level for the Seattle/Everett area as established and amended by survey from time to time by the United States Department of Housing and Urban Development. Presently, the maximum income levels are set at the amounts below:
(2) Senior Citizen: A person 62 years of age or older whose income provides the primary financial resources for the household in which the citizen is a full time resident.
(3) Disabled: A citizen whose income provides the primary resources for the household in which the citizen is a full time resident and who has a physical impairment of such a nature as to materially affect the number and types of employment for which the individual can reasonably qualify. See Resolution 1312 for further definition.
Print this form and submit to City Hall with supporting documents.
Are you currently 62 years of age or older?
Are you handicapped?
How many persons live in your household?
-- Select One --
What was the household income for the past year?
-- Select One --
$38,751 - $44,300
$44,301 - $49,850
$49,851 - $55,350
$55,351 - $59,800
$59,801 - $64,250
$64,251 - $68,650
$68,651 - $73,100
List sources of income:
Do you anticipate major changes in household income during the current year? If yes, please explain:
I hereby swear and affirm under the penalty of perjury that the information on this application is true and correct to the best of my knowledge and belief.
Required Supporting Documents
Verification of income of household (Include full previous year income tax returns with related schedules & current social security benefit statement)
Documentation of disability (if appropriate)
Verification of age (Copy of driver's license, birth certificate, passport, etc..)
Upload Supporting Documents
Please upload copies of your supporting documents as listed above or provide photocopies in person or via mail at Snohomish City Hall, PO Box 1589, Snohomish, WA 98291
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