(Sample) UTILITY USER'S TAX EXEMPTION/ELECTRIC & WATER LIFELINE RATE APPLICATION
Aug 11, 2021
submission
#13
Submit application
Your information
| First Name | --- |
| Middle Name/ Initial | --- |
| Last Name | --- |
| Service Address | --- |
| Apartment Number | --- |
| Mailing address (if different from Service Address) | --- |
| Best contact phone number | --- |
| Type of residence | Apartment/ Condo |
| 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) | --- |
| My annual income in the last year | --- |
| Upload income verification document (tax return, etc.) | --- |
LADWP Lifeline services
| LADWP Account Number | --- |
| Lifeline services requested | Electric, Water |
| Upload a copy of your most recent LADWP bill | --- |
Southern California Gas Lifeline Service
| SoCal Gas Account Number | --- |
| Upload a copy of your most recent SoCal Gas bill | --- |