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Senior Citizen Water Billing Discount Application
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The City of Portage offers a ten percent (10%) discount on water services for persons 65 years of age or older. The discount is applicable only to the customer's primary residence and only to the water base quarterly charge and usage charge for city-provided water. No discounts shall be applied to sewer charges.
After completing this form, print and sign the application then mail or deliver the form and proof of age (copy of driver license) to the City of Portage Treasury Office, 7900 South Westnedge Avenue, Portage MI 49002
Name on Utility Account (First, Mi., Last)
Driver License #
By affixing my signature, I hereby state that the information I have provided in this application is true and correct. I agree to provide proof age eligibility. I understand that if I receive the Senior Citizen Water Billing Discount by using misleading or false statements, I may be required to pay back the utility subsidy I received. I understand that this information is used solely to determine eligibility for the Senior Citizen Water Billing Discount.
I hereby request a ten percent (10%) Senior Citizen Water Billing Discount on water charges at my homestead.
Signature ______________________________________________________________________ Date ________________________
FOR TREASURY USE:
Input and approved by ____________________________________ Date ____________________
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