Black Diamond, WA · King County
Lifeline Utility Discount Application
Black Diamond residents use this application to request a utility discount and provide household, eligibility, and income information.
What this form is
The application is for residents seeking a Lifeline utility discount for water, sewer, or stormwater service. It asks for applicant and utility account details, household members and income, and information supporting an eligibility category; applicants must submit income documents. Renters and lessees also need a Resident Verification form completed by the property manager or owner.
Who needs it
Black Diamond residents seeking the discount who meet one of the listed eligibility categories and household income limits should complete the application.
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 document is signed and dated without a notary; the signer certifies statements under penalties of law and perjury, and the form does not identify a notarized attachment.
How to submit this form
- 1
Download the Application
Download the Lifeline Utility Discount Application.
- 2
Complete the Application
Enter applicant and utility account information, household details, eligibility information, and total annual combined household gross income.
- 3
Gather Required Documents
Include all income documents. If you rent or lease, obtain a Resident Verification form completed by the property manager or owner.
- 4
Sign and Submit
Sign and date the application, then submit it to the city department named on the form.
Frequently asked questions
- Who can apply for the Lifeline utility discount?
- The form lists residents age 62 or older, receiving in-home kidney dialysis, disabled or guardians of a disabled minor, or veterans with a VA-determined 100% service-connected disability. Household income limits also apply.
- What documents must I include?
- The application says all income documents must be submitted with it. Renters and lessees also need a Resident Verification form completed by the property manager or owner for the listed types of housing.
- Do I need a notary for the Lifeline Utility Discount Application?
- No. The application has a signature and date field but no notary block. The signer certifies the statements under penalties of law and perjury; no notarized attachment is identified.
- How do I submit the Lifeline 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 Lifeline Utility Discount Application doesn’t need a notary — but if you have another Black Diamond form that does, a commissioned online notary can help.