Utility Tax Refund Application - City Of University Place 2007 printable pdf download

Utility Tax Refund Application - City Of University Place 2007

City of University Place

UTILITY TAX REFUND APPLICATION

Eligibility: In order to be eligible for a Utility Tax Refund, you must be a low income household as defined by

the following and have lived in University Place for 9 months or more in 2007:

LOW INCOME: Means a household earning less than fifty percent (50%) of median income as defined by the

U.S. Department of Housing and Urban Development. For refunds on your 2007 utility tax, the income

eligibility levels are as follows (please check income level):

Household Size

Annual Gross Income

One person

$21,750

Two persons

$24,850

Three persons

$27,950

Four or more persons

$31,050

REFUND REQUEST PROCEDURE: In order to verify refund eligibility, you must provide the following

documentation:

A. A copy of your 2007 Federal income tax return or 2007 Social Security Administration form SSA 1099 (see

reverse for example of this form).

B. A list of names of all occupants residing in household. (Use space provided below.)

C. Proof of 9 months or more of University Place residency. (See reverse for acceptable forms of proof)

D. If you are requesting a refund for your natural gas utility tax, you must provide a copy of your natural gas

bill.

E. Complete the information below, sign the form and return it and the required documentation to University

Place City Hall, 3715 Bridgeport Way W. Ste. B-1, University Place, WA 98466-4456, not later than June

30, 2008.

APPLICANT INFORMATION

NAME:

PHONE:

STREET ADDRESS:

APARTMENT #:

ZIP CODE:

MAILING ADDRESS (if different than above):

CITY:

STATE:

ZIP:

HOUSEHOLD RESIDENTS:

I declare under penalty of perjury of the laws of the State of Washington that the above information is true and

correct. I understand falsification of any documentation required for this refund is cause for denial of this application.

Signed at University Place, Washington on

Date

Signature

Utility Tax Refund Application - City Of University Place 2007

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