White Settlement, TX · Tarrant County
Waiver of Penalties for Senior Resident
This form lets eligible White Settlement residential utility account holders request a waiver of penalties and late fees on their account.
What this form is
Residents age 62 or older may use this form to request a waiver of penalties and late fees on their utility account. The waiver applies only to residential account holders who occupy the premises. The form asks for the residential address, account number, date of birth, driver’s license number, signature, and date; the Utility Office section records who received it and when.
Who needs it
A residential utility account holder age 62 or older who occupies the premises and wants to request a waiver of account penalties and late fees.
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 form is signed and dated without a notary; it lists no notarized or sworn attachment, so the resident just signs and dates it.
How to submit this form
- 1
Download The Form
Download the Waiver of Penalties for Senior Resident form.
- 2
Complete The Form
Enter the requested account and resident information, then sign and date the request.
- 3
Check For Attachments
The form lists no attachments to gather.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who can request a waiver with this form?
- Residents age 62 or older may request a waiver. It applies only to residential utility account holders who occupy the premises.
- What information does the form ask for?
- It asks for the residential address, account number, date of birth, driver’s license number, signature, and date.
- Do I need a notary for the Waiver of Penalties for Senior Resident?
- No. The form is signed and dated without a notary, and it lists no notarized or sworn attachment.
- How do I submit the waiver request?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Waiver of Penalties for Senior Resident doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.