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Document Signers
    • 1 Applicant

    • 2 Utility Department


Signature HereClick to Sign
01/16/2019Click to Sign
I.N.Will Update Upon Signing

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Additional Signatures Required

Proof of Identity (REQUIRED) - Copy of valid Washington State Driver’s license, Passport, Permanent Resident Card or State Identification Card, showing picture, address and date of birth.
Utility Rebate Residency Verification Form (REQUIRED)
Tax Return (Required for those who file taxes) - All pages of return are required along with copies of source of income
Form W-2, Wages
Form SSA-1099, Social Security Retirement Benefit (SSA) Statement
Social Security Insurance (SSI) Benefits Letter
Form #1099 for Pension, IRA, Dividends, Interest, Minimum Retirement Distribution (MRD)
DSHS Benefits Letter for food, cash, and/or medical (All pages)
(State of Washington) Unemployment Compensation Payments Statement
Child Support or Alimony Statement
Veterans Administration Benefit Award Letter
Labor & Industry (L & I) Payment Statement
Any other sources(s) of income
Comcast Bill (Required if applying for Comcast rebate)