Senior/Disabled Discount Renewal Form

If you are a current user of the Senior or Disabled Discount Program, you will need to renew your application annually.

2024 Senior/Disabled Discount Renewal Form (PDF)

Dear Customer, The 2024 Senior/Disabled Discount renewal time is here. Please complete this form, attach the required income verification for your household and return it to the District prior to May 31, 2024. Each household approved for the discount by the District will receive a discount for each billing period during the upcoming calendar year. Please find acceptable forms of income below:

Acceptable Income Verification: 2023 income tax return

If you do not file taxes: Current SSI award letter (total benefits paid prior to deductions) or Current L&I pension verification letter

Please return all required documentation in the enclosed envelope or email/fax your forms directly to the Customer Service Department prior to May 31, 2024.

If we do not receive this signed form and your required household income verification before May 31, 2024, your discount will end.

Please Complete All Applicable Fields Below

Name(Required)
Qualified Discount Type(Required)
Total Household Income Guidelines for 2024(Required)
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