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! Utility Assistance Program
The City of Gonzales is offering a Utility Assistance Program for low income individuals who qualify.
This program provides an annual discount of $180 to qualifying residents. The program is on a first – come basis as funding is available. The Utility Assistance Program is not retroactive. The program will open on October 1st of every year and applications are due November 30th at 5pm. If approved, rebates will be given in December as a credit on your utility bill.
QUALIFICATIONS
1) The utility bill must be in your name.
2) You must live at the address where the discount will be received. 3) Someone in your household must be enrolled in a qualified public assistance program. 4) You will be required to provide proof of eligibility. 5) This program is for residential customers who have individually metered households. If you live in a multifamily structure serviced by one master or shared meter, then the program does not apply to you. 6) You are required to reapply to the program every two years. 7) You 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.
8) You must notify the City of Gonzales if your household no longer qualifies for the low-income discount.
QUALIFIED ASSISTANCE PROGRAMS
You are eligible if someone in your household is enrolled in one or more of the following assistance programs:
Bureau of Indian Affairs General Assistance Medicaid/Medi-Cal for Families A & B CalFresh SNAP National School Lunch Program (NSLP)
CalWORKS/Temporary Assistance for Needy Families (TANF) Supplemental Security Income (SSI) CARE (gas & electric company discount Tribal TANF
Head Start Income Eligible (Tribal only) Women, Infants, & Children Program (WIC)
Low-Income Home Energy Assistance Program (LIHEAP)
For questions regarding your application or required documents, 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.
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! Utility Assistance Program Application
Name (on water bill): ______________________________________________ Date: _______________ Service Address: __________________________________________ Phone: _____________________ Mailing Address: ________________________________ City: _______________ Zip Code: ________ 1) Someone in my household is enrolled in one or more of the following (select all that apply):
Bureau of Indian Affairs
General Assistance
Low-Income Home Energy
Assistance Program (LIHEAP)
Supplemental Security Income
(SSI)
CalFresh SNAP Medi-Cal for Families A & B Tribal TANF CARE (gas & electric company
discount)
National School Lunch Program
(NSLP)
Women, Infants, & Children
Program (WIC)
Head Start Income Eligible
(Tribal only)
By signing this application, I certify that all information and supporting documents provided for this application are true and correct. I agree to provide proof of eligibility if asked. I agree to notify the City of Gonzales if I no longer qualify for the Low – Income Utility Assistance. I understand that if I receive the discount without qualifying for it, I will be required to pay back the discount I received. ____________________________________________________________ _________________ Applicant Signature Date
___________________________________________________________________________________ Office Use Only:
Date Received: ______________ Does the applicant qualify? Yes No Received By: ________________
STEP 1: CUSTOMER INFORMATION
STEP 2: ELIGIBILITY
STEP 3: DECLARATION