Laserfiche WebLink
l'f 5'UF' <br /> FAN AfL`ARCOs <br /> City Application for Utility Payment Assistance <br /> This utility assistance payment program is a collaboration between the City of San <br /> Marcos and our four partnering agencies: Business and Community Lenders (BCL) of <br /> Texas; Community Action, Inc., of Central Texas; Communities in Schools; and <br /> Salvation Army of San Marcos <br /> Utility payment assistance is for the residents of San Marcos <br /> with City of San Marcos utility services. <br /> Date <br /> Name of account holder(Must be in Household) <br /> Client Name <br /> Relationship to applicant <br /> Date of birth <br /> Phone Number <br /> Service address <br /> Mailing address if different <br /> Email address <br /> If you submit this application on behalf of the account holder, please provide your <br /> contact information and reason for submitting on their behalf. <br /> 1. Do you receive one of the following? Check all that apply <br /> ❑ Free/Reduced Price Lunch (FRPL) <br /> ❑ Supplemental Nutrition Assistance Prog (SNAP) <br /> ❑ Supplemental Nutrition Program for Women, Infants and Children (WIC) <br /> ❑ Medicaid ❑ Medicare ❑ Children's Health Insurance Program (CHIP) <br /> The following documents are required: <br /> • Identification: This may include driver's license, passport, Enhanced Library card, <br /> US Military ID or Veteran ID Card (VIC), or other Government Issued ID. <br /> • Proof of Income (s): This may include check stubs (weekly-4 stubs, bi-weekly-2 <br /> stubs, monthly-1 check stub; Self-employment-bank statement or P&L statement, <br /> Supplemental Security Income (SSI), Military pay documentation <br /> • Supporting documentation of emergencies or economic hardship. <br /> • Recent utility billing statement <br />