LIRA Application - Del Oro Water

LIRA Application Form

Notice and application for the 2021-22 Low Income Ratepayer Assistance Program STIRLING BLUFFS DISTRICT Application For Del Oro Water Company’s Low Income Ratepayer Assistance Program Primary Residential Customer

I am a primary residential customer of Del Oro Water Company (DOWC). Please indicate below:

Your name as shown on your Del Oro account(Required)

First Last

Address where you receive Del Oro water service(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Del Oro Account Number(Required)

Starts with 005

Primry Phone Number(Required)

Type(Required)

Secondary Phone Number

If Applicable

Type

Number of persons living in your household

*Please attach a copy of your PG&E bill showing CARE discount or other proof of income for eligibility verification By consenting below, I certify under penalty of perjury that this information is true and correct under the laws of the state of California. I will provide proof of income and I will notify Del Oro Water Company of any changes that affect my eligibility.

File

Max. file size: 2 MB.

Date(Required)

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SUBMISSION DATE