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2. WAIVER OF PENALTIES FOR SENIOR RESIDENT

   Residents age sixty-two (62) or over may request a waiver of penalties and late fees on their account. The waiver applies only to residential account holders who occupy the premises. 

4. First Name*
5. Last Name*

7. I request that all penalties and late fees be waived from my utility account, effective immediately, from the date of this request.

9. Address*
11. Account Number*
13. Date of birth*
14. Upload clear picture of driver's license or state id*
16. Digitally sign by typing your name*
17. Today's Date*
    Today's Date
Leave This Blank:


19. Submit

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