Who can apply for the South Bend utilities discount?

Applicants must meet the form’s criteria, including living permanently at the service address, receiving a City utility bill in their name, and meeting the listed income requirements.

How do I submit the utilities discount application?

Bring the completed application and photo ID showing your age or date of birth to South Bend City Hall, 1102 W. First Street. The form says not to mail or fax it.

What information does the application ask for?

The form asks for your name, Washington driver’s license or ID number, address, phone number, age, date of birth, signature, and date.

South Bend, WA · Pacific County

No notary required

Application for Utilities Discount for Low Income Citizens

South Bend residents who meet the listed income and residency criteria use this application to request a discount on water and sewer service charges.

What this form is

This application lets eligible South Bend utility customers request a low-income discount on water and sewer service charges. Applicants must meet the listed household, income, and residency criteria, and update the application annually. The form asks for the applicant’s name, identification number, address, phone number, age, date of birth, signature, and date. Applicants must bring photo identification showing age or date of birth.

Who needs it

South Bend utility customers who meet the application’s income, residency, and other eligibility criteria can use it to request a discount.

How to submit it

Bring the completed application and a driver’s license or other photo ID showing age or date of birth to South Bend City Hall, 1102 W. First Street. The form says not to mail or fax it; it must be delivered in person.

About notarization

This document is signed without a notary; the applicant certifies eligibility under penalties of perjury, and no separate notarized attachment is listed.

How to submit this form

1
Download the Application
Download the South Bend application for a low-income utilities discount.
2
Complete the Application
Fill in your name, identification number, address, phone number, age, and date of birth, then sign and date the form.
3
Gather Photo Identification
Bring a driver’s license or other photo ID that shows your age or date of birth.
4
Deliver It to City Hall
Bring the application and photo ID to South Bend City Hall, 1102 W. First Street. Do not mail or fax the form.

Frequently asked questions

Do I need a notary for the South Bend utilities discount application?: No. The document is signed without a notary. The applicant certifies eligibility under penalties of perjury, but no separate notarized attachment is listed.
Who can apply for the South Bend utilities discount?: Applicants must meet the form’s criteria, including living permanently at the service address, receiving a City utility bill in their name, and meeting the listed income requirements.
How do I submit the utilities discount application?: Bring the completed application and photo ID showing your age or date of birth to South Bend City Hall, 1102 W. First Street. The form says not to mail or fax it.
What information does the application ask for?: The form asks for your name, Washington driver’s license or ID number, address, phone number, age, date of birth, signature, and date.

Need something notarized?

This Application for Utilities Discount for Low Income Citizens doesn’t need a notary — but if you have another South Bend form that does, a commissioned online notary can help.