La Palma, CA · Orange County
Annual Residential Utility Users Tax Exemption Application
La Palma residents use this application to request an exemption from utility users taxes based on household income.
What this form is
This application lets a resident claim an exemption from utility users taxes for listed utility services at their residence. The form says an application must be received or renewed by February each year and that eligibility is based on the prior year's income. Applicants provide household and utility account information, certify their eligibility, and attach household income tax returns or, when no return is filed, Social Security benefit or pension statements.
Who needs it
La Palma residents seeking a utility users tax exemption who meet the listed household income criteria should complete this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This application is signed without a notary; the applicant certifies under penalty of perjury, and the form does not say income attachments must be notarized.
How to submit this form
- 1
Download The Application
Download the Annual Residential Utility Users Tax Exemption Application.
- 2
Complete The Form
Enter applicant, household, and utility account information, and certify that you meet the stated criteria.
- 3
Gather Income Documents
Attach household members' individual income tax returns, or Social Security benefit or pension statements if no tax return is filed.
- 4
Submit To The City
Submit the application to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the application request?
- It requests an exemption from utility users taxes and asks for applicant, household, and utility account details, plus income documentation.
- When must I apply or renew?
- The form says the application must be received or renewed by February each year. It bases the exemption on prior-year income.
- Do I need a notary for this application?
- No. The application is signed without a notary, though the applicant certifies under penalty of perjury. The form does not say income attachments must be notarized.
- How do I submit the application?
- Submit it to the city department named on the form; check the city website for current contact details.