Full Text
City of Kalispell Post Office Box 1997 - Kalispell, Montana 59903 Telephone: (406) 758-7701 Fax: (406) 758-7758 COVID-19 VULNERABLE EXEMPTION FORM The Governor’s Phase Two Directive allows for utility disconnect exemptions for individuals who are defined as vulnerable and are still sheltering at home. However, the vulnerable individuals must also currently be “suffering a significant financial hardship as a result of the outbreak” to benefit from the protection from utility shutoff and suspension of late fees. Vulnerable Definition: “People over 65 years of age, people with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, or asthma, and people whose immune system is compromised such as by chemotherapy for cancer or other conditions requiring such therapy.” Please provide confirmation that you meet the vulnerable exemption as stated above by checking the following boxes that apply and providing the following information. Utility Account Number Name of Individual Requesting Exemption Address Phone Number I am a “vulnerable individual” as defined above. I have suffered a significant financial hardship as a result of the outbreak. I am currently sheltering at home due to the COVID-19 emergency. I understand that I must and will inform the City if I am no longer sheltering at home. The City of Kalispell will begin to charge late fees and/or proceed to disconnect service 30 days after the above-named individual ceases to shelter at home or until the end of the emergency, whichever is sooner.