Cloverdale, CA · Sonoma County
Utility Users’ Tax Senior Exemption Application
Residential customers who meet the senior and program eligibility requirements use this application to request a Cloverdale utility users’ tax exemption.
What this form is
This application lets eligible residential customers request an exemption from the utility users’ tax on telephone, gas, and/or electricity services. The qualifying senior must be at least 65, head of household, and qualify for California LifeLine or CARE. The application asks for applicant and utility account details, and requires proof of age and residence plus a copy of the bill stub showing the account holder and account number.
Who needs it
A residential customer applying for the exemption must be a qualifying senior or an applicant acting for one who meets the age, household, and program requirements.
How to submit it
Mail the application to City of Cloverdale, Attn: UUT Administrator, PO Box 217, Cloverdale, CA 95425. Include proof of age and residence and a copy of the telephone or PG&E bill stub showing the account holder and account number.
About notarization
This application is signed and dated without a notary; the applicant declares under penalty of perjury that the information is true and correct and attaches proof of age and residence.
How to submit this form
- 1
Download The Application
Download the Utility Users’ Tax Senior Exemption Application.
- 2
Complete The Application
Print clearly and enter applicant details and the telephone or PG&E account information as it appears on the bill.
- 3
Gather Required Attachments
Attach proof of age and residence and a copy of the bill stub showing the account holder name and account number.
- 4
Sign And Mail The Application
Sign and date the declaration, then mail the application and attachments to the UUT Administrator at the address on the form.
Frequently asked questions
- Who can apply for the senior utility users’ tax exemption?
- The qualifying senior must be at least 65, head of household at a residential service address, and qualify for California LifeLine or the CARE program.
- What documents should I attach?
- Attach proof of age and residence, such as a copy of a current California driver’s license or identification card, and a bill stub showing the account holder name and account number.
- How do I submit the senior exemption application?
- Mail it to City of Cloverdale, Attn: UUT Administrator, PO Box 217, Cloverdale, CA 95425, with the required proof and utility bill stub.
- Do I need a notary for the senior exemption application?
- No. Sign and date the application without a notary; its declaration is made under penalty of perjury, and proof of age and residence must be attached.
Need something notarized?
This Utility Users’ Tax Senior Exemption Application doesn’t need a notary — but if you have another Cloverdale form that does, a commissioned online notary can help.