Raymond, WA · Pacific County
Utility Discount Application
Raymond utility account holders use this application to request a reduced utility rate and provide household income information and proof of income.
What this form is
The application lets eligible owners or renters of single-family residences within Raymond city limits request a utility discount based on total household income. Applicants provide account and household details, list gross income for all occupants, and submit proof of income each year. The form includes a certification affidavit and states that an approved discount takes effect with the first billing cycle after the application date.
Who needs it
A utility account holder who owns or rents a single-family residence within Raymond city limits and meets the household income limits may apply.
How to submit it
Submit the application and proof of income to the City Utility Clerk at 230 2nd Street, Raymond, WA 98577.
About notarization
This document is signed without a notary; the claimant swears to the truth of the statements in the certification affidavit and signs and dates the application.
How to submit this form
- 1
Download The Application
Download the Utility Discount Application PDF.
- 2
Complete Applicant And Income Details
Fill in the applicant, household, service, and account information and list gross income for all household members.
- 3
Gather Income Proof
Include copies of income documentation for the household.
- 4
Sign And Submit
Sign and date the certification affidavit, then submit the application and income proof to the City Utility Clerk at the address on the form.
Frequently asked questions
- Do I need a notary for the Utility Discount Application?
- No. The application has no notary block; the claimant signs the certification affidavit, which states that the information is sworn under penalties of perjury.
- Who can apply for a Raymond utility discount?
- The utility account holder must own or rent a single-family residence within Raymond city limits, and all household members' combined annual gross income must meet the form's limit.
- What information and documents does the application ask for?
- It asks for applicant, household, service, and account details; gross income for all occupants; and copies of income documentation.
- How do I submit the Utility Discount Application?
- Submit the application with proof of income to the City Utility Clerk at 230 2nd Street, Raymond, WA 98577.