Signal Hill, CA · Los Angeles County
Domestic Low Income Discount Customer Application
Signal Hill residents can use this application to request a low-income discount on the water bill for their primary residence.
What this form is
This application requests the City of Signal Hill Domestic Low Income Discount for a primary residence in the city. Applicants provide household size and gross annual income, water account and contact details, and proof of income; the city reviews the discount annually. The form says the discount appears on the water bill for the period following receipt and approval of the completed application.
Who needs it
Signal Hill water utility customers seeking the Domestic Low Income Discount for their permanent primary residence should complete this application.
How to submit it
Complete the application and email it with proof of income to [email protected]. Questions can be directed to (562) 989-7318.
About notarization
This document is signed without a notary; the signer declares under penalty of perjury that the application statements are true and that they qualify.
How to submit this form
- 1
Download The Application
Download the Domestic Low Income Discount Customer Application.
- 2
Complete The Application
Enter household size, gross annual household income, water account details, contact information, and sign and date the form.
- 3
Gather Proof Of Income
Attach the income proof listed on the application: a 2025 Form 1040/540 with supporting schedules, or an alternative proof listed on the form.
- 4
Email The Application
Email the completed application and required documentation to [email protected].
Frequently asked questions
- Do I need a notary for the Domestic Low Income Discount Customer Application?
- No. The application is signed without a notary, but the signer declares under penalty of perjury that the statements are true and they qualify.
- How do I submit the application?
- Email the completed application and proof of income to [email protected]. The form lists (562) 989-7318 for questions.
- What proof of income does the application request?
- The form lists a 2025 Form 1040/540 and supporting schedules, or, if a 1040 is not required, Form SSA-1099 or verification of benefits.
Need something notarized?
This Domestic Low Income Discount Customer Application doesn’t need a notary — but if you have another Signal Hill form that does, a commissioned online notary can help.