City of Auburn

utilities@auburnwa.gov

1 East Main ST, Auburn, WA 98002

Print Document

When you click Print below we will prepare a printable document for you. It will automatically download when it's ready.

Did you know?
You can fill in the document online and then click the print icon and all of your information will be populated in the printable document, saving you time later.

SeamlessDocs

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.

Full Legal Name

Your Initials

Signature Type

Type Draw Upload Custom

Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Additional Signatures Required

Attach Documents

Please upload the following attachments:

There is a 250MB limit on each attachment.

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. Click Here to Upload

Tax Return (REQUIRED) - All pages of return are required along with copies of source of income Click Here to Upload

Form W-2, Wages Click Here to Upload

Form SSA-1099, Social Security Retirement Benefit (SSA) Statement Click Here to Upload

Social Security Insurance (SSI) Benefits Letter Click Here to Upload

Form #1099 for Pension, IRA, Dividends, Interest, Minimum Retirement Distribution (MRD) Click Here to Upload

DSHS Benefits Letter for food, cash, and/or medical (All pages) Click Here to Upload

(State of Washington) Unemployment Compensation Payments Statement Click Here to Upload

Child Support or Alimony Statement Click Here to Upload

Veterans Administration Benefit Award Letter Click Here to Upload

Labor & Industry (L & I) Payment Statement Click Here to Upload

Any other sources(s) of income Click Here to Upload

Comcast Bill (Required if you are applying for Comcast discount) Click Here to Upload

Sign Now!

Please provide accurate information below to ensure the delivery of the signed copies of the document.

Listed Signers

	Signer Details	Me?
Applicant
I'm not a signer listed above