(Sample) UTILITY USER'S TAX EXEMPTION/ELECTRIC & WATER LIFELINE RATE APPLICATION
Jul 13, 2022
submission
#16
Submit application
Your information
| First Name | --- |
| Last Name | --- |
| Service Address | --- |
| Apartment Number | --- |
| Best contact phone number | --- |
| Type of residence | Single residence/ home |
| Number of people in household | --- |
| Date of Birth | --- |
| Last 4 digits of SSN | --- |
| Copy of your Driver's license or ID Card (for Senior age verification) | --- |
| I am requesting Lifeline services because I am | Senior citizen (over 62) |
| My annual income in the last year | --- |
| Upload income verification document (tax return, etc.) | --- |
LADWP Lifeline services
| Are you requesting LADWP Lifeline services? | No |
| Lifeline services requested | Electric |