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Low Income Senior or Permanently Disabled Utility Rate Reduction Application

  1. Verification*

  2. My combined annual household income is:*

    Please Check One

  3. This income figure includes all earned income as well as retirement income, social security benefits, disability benefits, investment income, interest income, capital gains, and net rental income from all real estate. A credit against annual household income for property taxes (with proof) shall be used in calculating whether an applicant is qualified for the discount or not. My income does not exceed the above-indicated amount. I hereby make application for a utility rate reduction.

    AFFIDAVIT: I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.

  4. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  6. This field is not part of the form submission.