Application For $140 Credit Seniors Water/Sewer Relief Program

Water Account Number:

Email Address

Street Address:

Municipality

Postal Code:

Telephone:

List of all registered owners and relationship to applicant.

Last Name:

First Name:

Date of Birth

Relationship:

Last Name:

First Name:

Date of Birth:

Relationship:

A copy of the required documents showing any person listed as an owner of the property who is in receipt of the following supplement must accompany this application:

PROOF OF:

GUARANTEED INCOME SUPPLEMENT (GIS)

Form T4A-OAS (Box 21 must show income) or Notice of Qualification for previous tax year

AGE (65 OR OLDER)

Federal or Ontario Citizen Card, Birth Certificate, Driver's Licence or Passport

Files Upload - Proof of Guaranteed Income Supplement (GIS) and Age (65 or Older)

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In order for the relief to be processed and granted in a timely fashion, this application must be completed and received in the municipal office on or before October 31st of each year. The application will not be processed unless all required information has been provided.

STATEMENT

(1) I am the registered owner and this is my principal residence.

(2) I, the applicant, declare the above information to be correct and complete to the best of my knowledge and belief and the Municipality may verify any and all information pertaining to this application.

(3) I acknowledge that application for relief must be made on an annual basis.

Date of Application:

Name of Applicant:

Signature of Applicant:

Clear

CRITERIA FOR $140.00 CREDIT SENIORS WATER/SEWER RELIEF PROGRAM

1. The applicant must be 65 years of age or older. Proof of age must be submitted with the application.

2. The applicant must own and occupy the property as their principal residence.

3. The applicant must be in receipt of benefits from the Guaranteed Income Supplement (GIS) program (for the previous tax year) identified on the application. Proof of receipt of benefits from the program must be submitted with the application.

4. An application must be submitted to the Municipality each calendar year between May 1 st and October 31st. There are no exceptions to the deadline.

5. One credit per water/sewer account per year will be granted.

6. Once approved, the credit will be applied to the water/sewer account in November of the current year. The credit will appear on the next billing issued after the adjustment. No cash refunds. Credit is not transferable. Owners are required to pay their bills as they come due.

7. For those on the Monthly Pre-Authorized Payment Plan, the credit will be taken into consideration when payments are withdrawn from the bank.

8. For further details please contact the Town at 905-871-1600.

Personal information is collected pursuant to the Municipal Act, S.O. 2001, as amended and will be used solely for the purpose of processing applications under the Senior's Utility Relief Fund (SURF) and is necessary for the proper administration thereof. Questions about the collection of this information can be made to the Record's Coordinator at 905-871-1600 ext. 2214.