Who can apply for the Brookville utility discount?

The form lists age or permanent and total disability, household income within the program limit, and receiving a Brookville utility bill for your primary residence as qualifications.

What documents and information does the application request?

It requests household and income details and says to include copies of supporting income documentation. Applicants claiming disability also complete the certificate, which says all copies must be signed by a physician.

Do I need a notary for the utility discount application?

No. The applicant signs the affidavit without a notary. If completing the disability certificate, a physician must sign all copies.

Brookville, OH · Montgomery County

No notary required

Senior Citizen/Permanently and Totally Disabled Utility Discount Application

Brookville residents who are seniors or permanently and totally disabled use this application to request or renew a city utility discount.

What this form is

This application lets eligible Brookville residents request or renew a utility discount. The form lists qualifications including age or permanent and total disability, household income within the program limit, and a Brookville utility bill for the applicant’s primary residence. It asks for household and income information, supporting income documents, and signatures; applicants claiming disability also complete a certificate.

Who needs it

Brookville residents who meet the age or disability, income, and residence requirements and receive a city utility bill may apply or renew.

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 signs an affidavit, and a physician must sign all copies of the disability certificate.

How to submit this form

1
Download the Application
Download the utility discount application PDF.
2
Complete the Application
Select initial or renewal, provide household and income information, and sign the applicant affidavit.
3
Gather Supporting Documents
Include copies of supporting income documentation. If claiming disability, complete the certificate and obtain the required physician signatures on all copies.
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

Who can apply for the Brookville utility discount?: The form lists age or permanent and total disability, household income within the program limit, and receiving a Brookville utility bill for your primary residence as qualifications.
What documents and information does the application request?: It requests household and income details and says to include copies of supporting income documentation. Applicants claiming disability also complete the certificate, which says all copies must be signed by a physician.
Do I need a notary for the utility discount application?: No. The applicant signs the affidavit without a notary. If completing the disability certificate, a physician must sign all copies.
How do I submit the utility discount application?: Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Senior Citizen/Permanently and Totally Disabled Utility Discount Application doesn’t need a notary — but if you have another Brookville form that does, a commissioned online notary can help.