Low-Income Senior Rate application To participate in this program, you must qualify for the Liberty Utilities CARE program. Program requirements: Age 65 or older Current participation in the Liberty Utilities CARE program. Please include a copy of BOTH pages of your most recent billing showing participation in the CARE program. Permanent, Full time South Lake Tahoe resident at said address. Your account with South Tahoe Refuse Company must be in good standing. Name(Required) First Last Date(Required) MM slash DD slash YYYY Residence Address(Required)Mailing Address(Required)Telephone Number(Required)Birth Date(Required) MM slash DD slash YYYY Account Number(Required)Please read and initial the following: Acceptance of Terms(Required) In the event I no longer qualify for the CARE Program or the above premises are leased, rented, sold, transferred, conveyed or occupied by any other person or persons other than the undersigned, I agree to immediately notify South Tahoe Refuse Company and understand that the Qualified Senior Rate will end and the regular service rate will resume. Acceptance of Terms(Required) I agree to keep my account in good standing. Acceptance of Terms(Required) I declare under penalty of perjury, under the laws of the State of California, that the foregoing application and representations are true and correct. Executed this on: Date(Required) MM slash DD slash YYYY Signature(Required)Please include a copy of your most recent LIBERTY BILL showing participation in the CARE program AND a copy of your DRIVER'S LICENSE or IDAccepted file types: jpg, jpeg, png, gif.Additional FilesAccepted file types: jpg, jpeg, png, gif.Additional FilesAccepted file types: jpg, jpeg, png, gif.NameThis field is for validation purposes and should be left unchanged.
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