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CITY OF EVANSTON 1200 Main Street Evanston, WY 82930 Phone (307) 783-6300 Fax (307) 783-6390 Application for utility credit (Senior Citizen Discount) CITY CODE 23-28 Any person who occupies a dwelling as his home or principal residence and is age 65 years or older is entitled to a water, sewer, and garbage credit. No more than one fee credit in each category shall be allowed on the same property during any year. Application must be made annually. Account # _ Date: Name of Applicant: Service Address: Mailing Address: Phone Number: E-mail Address: Property Owner: Do you occupy the dwelling as your principal place of residence? Yes No Are you 65 years of age or older? Yes No Date of birth I hereby certify the above information to be true and correct and that no other credit claims have been or will be submitted by me during the remainder of the Fiscal year. Signature of Applicant Please return to the above address. OFFICE USE BD ○ Phone ○ List ○ Rate ○ Type ○ Location ○ Initial: Date: _ Pre-Date: _ SIGN