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Senior Service Charge Discount

  1. Please select the following exemption:*
  2. I am also aware that by completing this certification I will receive a discounted rate of $6.75 on the Infrastructure Service Charge on my water billing account.
  3. Upload your driver's license (Front)

  4. DISCLAIMER: By typing your name here, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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  6. This field is not part of the form submission.