147 Fourth Street · PO Box 647, Gonzales, CA 93926 · Phone: (831) 675-5000 · Fax: (831) 675-2644 https://gonzalesca.gov/
City of Gonzales
Small town, big heart! ~ ¡Pueblo chico, corazón grande! Senior Rebate Program
The City of Gonzales is pleased to offer an annual discount to senior citizens. The discount is 5% of the annual cost of water usage. Rebates will be given in December of each year as a credit on the utility bill. *The program is on a first come, first serve basis with limited funding available.
QUALIFICATIONS
• Utility account must be in your name and you must reside at the service address. • Utility account holder must be at least 65 years old. • Cannot have more than two (2) penalties in the 12 months preceding the month the rebate is given. This includes late fees and overdraft fees.
• Seniors must reapply bi-annually to qualify for the program. • Applications will open the 1st of October and close on November 30th of each year.
For questions regarding your application please contact City of Gonzales at 831-675-5000 or come to City Hall during normal business hours, Monday through Friday from 8:00AM to 5:00 PM.
Customer Name___________________________________________________________________________________ Service Address ____________________________________________ Phone Number _________________________ Mailing Address ___________________________________ City ________________________ Zip Code __________ Email Address ___________________________________________________________________________________ Date of Birth ________________ Age ________
I certify that I am eligible for a rebate on my water bill because I am 65 years of age or older and the utility account is in my name. I understand that if I receive the discount without qualifying for it, I will be required to pay back the discount I received.
Signature _____________________________________________________________ Date ________________
OFFICE USE ONLY
Received By ______________ Date & Time Received _________________ Identification Attached Entered into UB By __________