Rock Island, WA · Douglas County
Application for Low-Income Senior Citizen or Disabled Rates
Rock Island residents apply with this form for low-income rates on water, sewer, and garbage service and provide eligibility proof to the city clerk.
What this form is
This application is for senior citizens or disabled residents seeking low-income rates for water, sewer, and garbage service. It asks for the applicant’s name, account number, service and mailing addresses, phone number, and date. Applicants must provide the city clerk with proof of age or disability and low income; the form describes acceptable examples of that proof.
Who needs it
A senior citizen or disabled resident seeking low-income rates for water, sewer, and garbage service in Rock Island should complete this application.
How to submit it
Provide the required eligibility proof to the city clerk. The form does not give a submission address, email, or portal; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; it mentions 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 utility rates application.
- 2
Complete The Form
Enter the date, name, account number, service address, mailing address, and phone number.
- 3
Gather Eligibility Proof
Gather the proof of age or disability and low income required for your application.
- 4
Provide It To The City Clerk
Provide the application’s required eligibility proof to the city clerk; check the city website for current contact details.
Frequently asked questions
- Who can use the low-income utility rates application?
- Senior citizens or disabled citizens seeking low-income rates for water, sewer, and garbage service can use this application.
- What proof must I provide with the application?
- The form says senior applicants must provide picture identification showing they are 61 or older and proof of low income. Disabled applicants must provide proof such as a special parking privilege permit and proof of low income.
- Do I need a notary for the low-income utility rates application?
- No. The application has a signature and date line but no notary block; the signer just signs and dates it.
- How do I submit the low-income utility rates application?
- Provide the required eligibility proof to the city clerk. The form does not give an address, email, or portal, so check the city website for current contact details.
Need something notarized?
This Application for Low-Income Senior Citizen or Disabled Rates doesn’t need a notary — but if you have another Rock Island form that does, a commissioned online notary can help.