Eligible applicants for this program will have the late penalty charge waived on Electric and Water Utility bills. To be eligible:

• A written application must be filed with Customer Service.• Electric and/or Water service must be in the APPLICANT’S name.• Applicants for exemptions are allowed under one category: - Senior Citizens (65 years and older) - Disabled Veterans - Permanently and Totally Disabled

PENALTY CHARGE EXEMPTION APPLICATION

Senior Citizens (65 years and older) Disabled Veteran

Proof of status is required. Follow the directions below.

Permanently and Totally Disabled

Application For:(Choose One Only)

Senior Citizens (Only one is required)

Birth Certificate DAV Medical Card

Disabled Veteran Permanently and Totally Disabled

Proof Required:(Use copies—Do not enclose original documents since they will not be returned)

Drivers License,plus one other ID

Baptismal Record

Other VA ID

Award Letter from Social Security Administration Office

Name Phone Number

Social Security Number Age

Address (Street, City, State, Zip)

Elecrtic Account Number Water Account Number

Signature

Preparer’s Signature

Preparer’s Phone Number

VINELAND MUNICIPAL UTILITIES640 WOOD ST. PO BOX 1508VINELAND, NJ 08362-1508VMEU@VINELANDCITY.ORG