Annual Application For Utility Users Tax Exemption - City Of Moreno Valley - 2014 Page 2
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1
2City of Moreno Valley
Financial & Management Services Department
Proof of Income
Proof of “gross household income” must be submitted with your application.
For UUT Exemption, the definition of “gross (before taxes) household income” is all money
and non-cash benefits, available for living expenses, from all sources, both taxable and non-
taxable, before deductions, for all people who live in the residence. This includes, but is not
limited to, the following:
l Wages or salaries (at least two current check stubs or four check stubs if paid weekly)
l Bonuses, tips
l Gross amounts of pensions and/or annuities
l Interest or dividends from savings accounts, stocks/bonds, or retirement accounts
l Retirement benefits
l Social security, SSI, SSD
l Unemployment benefits
l Prior year’s income tax refunds
l Disability payments
l Life insurance benefits
l Capital gains
l Inheritances
l Scholarships, grants, or other aid used for living expenses
l Child support
l AFDC
l Food stamps
l Foster care payments
l Workers’ compensation
l Insurance settlements
l Legal settlements
l Cash
l Spousal support
l Other support
When submitting your application for an exemption from the Utility User’s Tax, remember to enclose
gross household income, sign and date your application.
Return the application form to:
City of Moreno Valley
Finance — Utility Tax Exemption
P.O. Box 88005
Moreno Valley, CA 92552-0805
If you have any questions or need assistance filling out this application, please call 951.413.3090.
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