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City of Laramie Administrative Services P.O. Box C Laramie, Wyoming 82073 [PHONE REDACTED] Dear Citizen: We are excited to announce that the council passed ordinance 1868 to establish Low Income Affordable Municipal Service Rates. Applicants who qualify will receive $37.58 towards the Municipal Services bill. EGIBILITY REQUIREMENTS: The applicant must own the property where Municipal Services are being billed The applicant must reside at the address for at least nine months per year. The applicant must be able to demonstrate current enrollment in a federal program in which low income is a necessary qualification. o Accepted programs are: Social Security Supplemental Security Income (SSI) Women, Infants and Children (WIC) Low Income Home Energy Assistance Program (LIHEAP) Supplemental Nutrition Assistance Program (SNAP) Other federal income assistance programs as proof at the discretion of the City Manager’s Office or designee. The applicant must not have any delinquent amount associated with the Municipal Services bill. If the applicant’s change in status makes them ineligible the Municipal Services department needs to be notified. The applicant must re-apply for the program on an annual basis. The deadline for reapplication is June 1st every year. If you meet these qualifications, please complete the following application and provide the City of Laramie with copies of the necessary documents that show enrollment in a federal program with low income as a necessary qualification. If you have any questions, please call the Municipal Services Billing Department at 721-5222. Sincerely, Municipal Services Billing Department City of Laramie ---PAGE BREAK--- City of Laramie Administrative Services P.O. Box C Laramie, Wyoming 82073 [PHONE REDACTED] 1. HOW TO QUALIFY FOR LOW INCOME AFFORDABLE MUNICIPAL RATES? If you have met the qualifications, please complete the application and bring in a copy of the paperwork to demonstrate current enrollment in a federal program in which low income is a necessary qualification. 2. HOW DO I KNOW IF I QUALIFY? The City will send you a notice in the mail on your qualification. 3. WHEN WILL THIS TAKE EFFECT? After approval, the credit established by this ordinance will begin with the first day of the billing period after the application is approved. 4. HOW OFTEN IS THE RENEWAL? Annually on June 1st. 5. WHAT HAPPENS IF I NO LONGER QUALIFY? Households receiving the credit established by the ordinance shall report to the City of Laramie any change in circumstance. City of Laramie Administrative Services P.O. Box C Laramie, Wyoming 82073 [PHONE REDACTED] ---PAGE BREAK--- APPLICATION FOR LOW INCOME AFFORDABLE MUNICIPAL SERVICES RATE CITY OF LARAMIE, WY NAME: ADDRESS: NEW: RENEWAL:_________ SPOUSE BIRTHDATE OF OTHER PERSONS RESIDING IN HOUSEHOLD AND RELATIONSHIP: Name / Date of Birth Relationship DOCUMENTATION OF CURRENT ENROLLMENT IN FEDERAL PROGRAM Date enrollment became active in the program Yourself Spouse Social Security Supplemental Security Income (SSI) Women, Infants and Children (WIC) Low Income Home Energy Assistance Program (LIHEAP) Supplemental Nutrition Assistance Program (SNAP) Other Program: I certify that the above information and attachments provided by me is true and correct to the best of my knowledge and I understand that willful misrepresentation will result in loss of credit eligibility. Signature of Applicant Date For Official Use Only: Comments: Approval / Disapproval Pending: