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Vineland Municipal Electric Utility

 

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Text Box: PROOF OF STATUS IS REQUIRED.
FOLLOW THE DIRECTIONS BELOW.

PENALTY CHARGE EXEMPTION APPLICATION


  


 

 

 

 

 

 

 

 

 

GENERAL

INSTRUCTIONS

Eligible applicants for this program will have the late penalty

charge waived on Electric and Water Utility bills.† To be eligible:

 

 A written application must be filed with Customer Service.

 Electric and/or Water service must be in the APPLICANTíS name.

 Applicants for exemptions are allowed under one category:

ř Senior Citizens (65 years and older)

ř Disabled Veterans

ř Permanently and Totally Disabled

 

Complete ALL information requested.† Application must be signed and dated.

PLEASE PRINT CLEARLY.

 

 

APPLICATION FOR:

 

(Check one only)

††††††††† Senior Citizens (65 years and older)

 

††††††††† Disabled Veteran

 

††††††††† Permanently and Totally Disabled

 

 

APPLICATION INFORMATION

 

(Complete all information, regardless of exemption program you are applying for).

 

Name: ________________________________________________

 

Address: ______________________________________________

 

Phone: ________________________† Age: ___________

 

Social Security Number: __________________________

 

Signature: _____________________________________________

 

ACCOUNT NUMBERS:

Electric Acct: ________________† Water Acct: ________________

 

 

PROOF REQUIRED

 

(Use copiesóDo not enclose original documents since they will not be returned)

SENIOR CITIZEN

(Only one is required)

 

††††††††† Birth Certificate

 

††††††††† Drivers License,

††††††††† plus one other ID

†††††

††††††††† Baptismal Record

 

DISABLED VETERAN

 

 

††††††† DAV Medical Card

 

††††††† Other VA ID

PERMANENTLY AND TOTALLY DISABLED

 

††††† Award Letter

††††† from Social

††††† Security

††††† Administration

††††† Office

PREPARERíS INFORMATION

(Complete only if someone other than applicant prepared this form)

 

Preparerís Signature: ____________________________________

 

Preparerís Phone Number: ___________________________