Republic, WA · Ferry County
Senior Discount Age/Income Affidavit
Republic residents seeking a senior discount sign this affidavit to certify their age and household income or qualifying disability.
What this form is
The City of Republic requires a signed affidavit for an account to receive the senior discount, which applies only to single-family residences. The signer certifies they are at least 62 and either have combined household income of $24,000 or less annually, or can provide proof of disability and earn more than $24,000. The form also notes the affidavit needs to be signed once per year.
Who needs it
A Republic resident seeking the senior discount for a single-family residence must sign this affidavit and certify the stated age and income or disability criteria.
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 affidavit has no notary block, so it is signed without a notary; the signer just signs and dates it.
How to submit this form
- 1
Download the Affidavit
Download the Senior Discount Age/Income Affidavit.
- 2
Complete the Affidavit
Review the age and income or disability statements, then sign and date the form.
- 3
Check for Attachments
The affidavit does not list attachments; it mentions proof of disability for one eligibility option.
- 4
Submit to the City
Submit the signed affidavit to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Senior Discount Age/Income Affidavit?
- No. The affidavit has no notary block; the signer just signs and dates it.
- Who can qualify for the senior discount?
- The affidavit states that the signer must be at least 62 and have combined household income of $24,000 or less annually, or be able to provide proof of disability and earn more than $24,000.
- How do I submit the Senior Discount Age/Income Affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.
- How often do I need to sign the affidavit?
- The form says you only need to sign it once per year, even though it appears on every bill.
Need something notarized?
This Senior Discount Age/Income Affidavit doesn’t need a notary — but if you have another Republic form that does, a commissioned online notary can help.