Do I need a notary for the Water Service Protection Application?

No. The application has a signature and date field but no notary block; the signer certifies the information and authorizes the City to verify eligibility.

Who can apply for Toledo water service protection?

The application is for Toledo water account holders aged 65 or older whose household income is at or below 200% of the federal poverty level and who meet the other listed criteria.

What documents should I include with my application?

Attach a government-issued ID showing your date of birth, proof of income such as a recent tax return, pay stubs, or benefit statement, and a recent City of Toledo water bill.

How do I submit the application?

Submit the completed application and supporting documents in person at City Hall, by mail to 130 N. Second Street, Toledo, WA 98591, or by email to utilities@toledowa.us.

Toledo, WA · Lewis County

No notary required

Water Service Protection Application for Low-Income Seniors

Low-income Toledo residents aged 65 or older use this application to request water payment assistance and provide information supporting program eligibility.

What this form is

This application is for Toledo water account holders aged 65 or older seeking deferred payments, reduced payments, or arrearage forgiveness to help prevent water service shutoffs. It asks for applicant and household eligibility information, the requested program option, and supporting documents such as proof of age, income, and a recent water bill; City staff verify whether there are open code violations.

Who needs it

Toledo water account holders aged 65 or older who meet the listed income and eligibility criteria can use this application to request assistance.

How to submit it

Submit the completed application and documentation in person at City Hall, by mail to City of Toledo, 130 N. Second Street, Toledo, WA 98591, or by email to [email protected].

About notarization

This application is signed and dated without a notary; the signer certifies the information is true and complete and authorizes the City to verify eligibility.

How to submit this form

1
Download The Application
Download the Water Service Protection Application for Low-Income Seniors PDF.
2
Complete The Application
Fill in applicant information, check the eligibility criteria that apply, select a program option, and sign and date the application.
3
Gather Required Documents
Attach proof of age, proof of income, and a recent City of Toledo water bill. City staff will verify code violations.
4
Submit To The City
Submit the application and documents in person, by mail to City Hall, or by email to [email protected].

Frequently asked questions

Do I need a notary for the Water Service Protection Application?: No. The application has a signature and date field but no notary block; the signer certifies the information and authorizes the City to verify eligibility.
Who can apply for Toledo water service protection?: The application is for Toledo water account holders aged 65 or older whose household income is at or below 200% of the federal poverty level and who meet the other listed criteria.
What documents should I include with my application?: Attach a government-issued ID showing your date of birth, proof of income such as a recent tax return, pay stubs, or benefit statement, and a recent City of Toledo water bill.
How do I submit the application?: Submit the completed application and supporting documents in person at City Hall, by mail to 130 N. Second Street, Toledo, WA 98591, or by email to [email protected].

Need something notarized?

This Water Service Protection Application for Low-Income Seniors doesn’t need a notary — but if you have another Toledo form that does, a commissioned online notary can help.