Rock Island, WA · Douglas County
Low-Income Senior and Disabled Utility Rate Application
This application lets eligible seniors and people with disabilities request reduced water, sewer, and garbage service rates from the city.
What this form is
Use this application to request reduced rates for water, sewer, and garbage service as a low-income senior or person with a disability. The form asks for your name, account number, service and mailing addresses, phone number, and date. It also requires proof of eligibility, such as photo identification and income documentation for seniors, or disability and income documentation for applicants with disabilities.
Who needs it
Low-income seniors age 61 or older and people with disabilities who want to request reduced water, sewer, and garbage service rates should complete this application.
How to submit it
Provide the required eligibility documents to the city clerk. The form lists photo identification and income proof for seniors, or disability and income proof for applicants with disabilities.
About notarization
This document is signed and dated without a notary; it lists no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Low-Income Senior and Disabled Utility Rate Application.
- 2
Complete The Form
Fill in the date, name, account number, service and mailing addresses, and phone number.
- 3
Gather Eligibility Proof
Gather the identification and income proof required for seniors, or disability and income proof for applicants with disabilities.
- 4
Submit To The City Clerk
Provide the application and required eligibility documents to the city clerk.
Frequently asked questions
- Do I need a notary for the Low-Income Utility Rate Application?
- No. The application has a signature and date line but no notary block; the signer just signs and dates it.
- Who can apply for reduced utility rates?
- The form is for seniors age 61 or older and people with disabilities who meet the stated low-income criteria and provide the required proof.
- What proof should I provide with the application?
- Seniors should provide photo identification showing they are 61 or older and proof of income. Applicants with disabilities should provide disability and income proof. The form gives examples of income documentation.
- How do I submit the application?
- Provide the required eligibility documents to the city clerk. The form does not give a mailing address or online submission option.
Need something notarized?
This Low-Income Senior and Disabled Utility Rate Application doesn’t need a notary — but if you have another Rock Island form that does, a commissioned online notary can help.