Grass Valley, CA · Nevada County
Low Income Discount Application for 2019
Grass Valley residential utility customers use this application to request a 15% water and wastewater rate discount under the 2019 income requirements.
What this form is
This application requests the City of Grass Valley’s 15% discount on standard residential water and wastewater utility rates. Applicants must be authorized on the utility account, live at the service address, meet the listed household income limits, and satisfy the other eligibility requirements. The application asks for household and income information, a signature, and a separate completed IRS Form 4506-T for each household member age 18 or older.
Who needs it
A residential utility account holder seeking the 2019 low income discount must complete the application and provide the required information for their household.
How to submit it
Return the completed application and required IRS Form 4506-T forms to the City of Grass Valley Public Works Department, 125 E Main Street, Grass Valley, CA 95945.
About notarization
This application is signed and dated without a notary; each household member age 18 or older must also complete IRS Form 4506-T, which the document does not say must be notarized.
How to submit this form
- 1
Download The Application
Download the Low Income Discount Application for 2019.
- 2
Complete The Application
Fill in the service address and contact details, household members age 18 or older, total household income, and applicant signature and date.
- 3
Gather Required Forms
Complete an IRS Form 4506-T for each household member age 18 or older, including members who did not file a tax return last year.
- 4
Submit To The City
Return the completed application and all required IRS forms to the City of Grass Valley Public Works Department.
Frequently asked questions
- Who can apply for the 2019 low income discount?
- The applicant must be authorized on the service address utility account, live at that address, meet the listed income requirements, and satisfy the other qualifications on the form.
- What documents must I submit with the application?
- Submit the completed application and a completed IRS Form 4506-T for every household member age 18 or older, even if that person did not file a tax return last year.
- Do I need a notary for the Low Income Discount Application?
- No. The application is signed and dated without a notary. Each household member age 18 or older must complete IRS Form 4506-T; the document does not say that form must be notarized.
- How do I submit the Low Income Discount Application?
- Return all required completed documents to the City of Grass Valley Public Works Department at 125 E Main Street, Grass Valley, CA 95945.
Need something notarized?
This Low Income Discount Application for 2019 doesn’t need a notary — but if you have another Grass Valley form that does, a commissioned online notary can help.