Long Beach, WA · Pacific County
Low Income Senior Utility Discount Application
This application lets Long Beach residents age 65 or older request a discount on city water, sewer, and storm water base charges, with a property owner statement required for renters.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
The City of Long Beach uses this application to review requests for a low-income senior discount on utility base charges. Applicants must meet the stated age, residency, and income requirements, provide income documentation, and apply again each year. Renters must also have the property owner complete and sign the owner statement, which includes an acknowledgment before a notary.
Who needs it
Long Beach utility customers age 65 or older who meet the program’s income and residency requirements may apply; renters also need their property owner to complete the owner statement.
Why it needs a notary
The property owner signs the owner statement before a notary, using the form’s acknowledgment block; the senior customer’s certification has no notary block.
How to get this notarized
- 1
Download the Application
Get the Low Income Senior Utility Discount Application from the City of Long Beach.
- 2
Complete the Application
Fill in the customer and household information and report total gross annual household income.
- 3
Gather Income Records
Prepare the requested 2024 tax return with schedules or SSA-1099, plus supporting documentation for other income.
- 4
Book an Online Notary
If you rent, arrange for the property owner to sign the owner statement before a commissioned online notary.
- 5
Submit the Application
Return the application to the City of Long Beach and present the income documents in person as the form requires.
Preview the form
The blank PDF straight from Long Beach. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- Who must have a signature notarized on this application?
- The property owner must sign the owner statement before a notary when the applicant is a renter. The senior customer’s certification does not have a notary block.
- How do I apply for the Long Beach senior utility discount?
- Complete the application, gather the required income records, and have the property owner complete and notarize the owner statement if you rent. The form says to return the application to the City and present income documents in person.
- Do I need to provide income documents with the application?
- Yes. The form requests a 2024 IRS tax return with schedules or an SSA-1099, plus supporting documentation for other income. It says these documents must be presented in person to the City.
- Can I use an online notary for the owner statement?
- Washington authorizes remote online notarization by its notaries under RCW 42.45.280. Confirm with the city or town if unsure whether it will accept an online-notarized owner statement.