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Low-Income Senior Citizen/Low-Income Disabled Citizen Reduced Rate Program
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To print this application, please click on this link:
Application for Low-Income Senior Citizen/Low-Income Disabled Citizen Reduced Rate Program
Complete this form and return to the District either by mail or by dropping it off in the payment drop box. Don't forget to include your supporting documents!
Low-Income Senior Citizen/Low-Income Disabled Citizen Reduced Rate Program Application
Applicants must meet the following qualifications and certify that:
1) I am over the age of 61; AND
Please provide a copy of your government-issued ID, such as a driver’s license or identification card.
Copy of government-issued ID
2) I have a total annual gross income not exceeding $55,743 annually, including that of a spouse or any co-occupants(s); AND
Please provide a copy of your most recent income tax return.; AND
Copy of most recent income tax return
3) I already receive the property tax deferral/exemption for this property through Snohomish County.; AND
4) I own and reside in the residence noted below.
-OR-
1) I am permanently disabled at the time of this application; AND
Please provide proof of disability, in the form of a payment statement for SSI or SSDI.
SSI/SSDI Payment Statement
2) I have a total annual gross income not exceeding $55,743 annually, including that of a spouse or any co-occupant(s); AND
Please provide a copy of your most recent income tax return.
Copy of most recent income tax return.
3) I already receive the property tax deferral/exemption for this property through Snohomish County.; AND
4) I own and reside in the residence noted below.
First Name
*
Last Name
*
Service Address
*
City
*
Account/Customer Number
*
Phone Number
*
Email Address
I agree to notify the District should I move from this property, or if my gross annual income exceeds the amount above. I further agree to provide the District with financial information to support my application, and agree to provide future income information if requested by the District to verify my eligibility. I acknowledge that information provided by me in support of my application is a public record and subject to public disclosure. I agree to waive any claim of confidentiality in any information provided and I agree to release Mukilteo Water & Wastewater District, and its employees, agents, officers, and Commissioners from any liability or claims, which might arise from the disclosure of such information to any other party or entity. I certify, under penalty of perjury, under the laws of the State of Washington, that the foregoing is true and correct.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
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