Active Deployed Military Personnel Utility Service Fees Abatement Application

Active Deployed Military Personnel Utility Service Fees Abatement Application
General Guidelines
- Valid photo ID is required on the form. Please upload a copy when prompted and attach it to the application.
- Please note it can take up to 30 business days to process your submission.
- Fields with marked with a red asterisk (*) must be completed.
Qualifications
- Must be stationed outside of Utah for more than 60 days.
- Must have deployment orders.
Important*

All information provided as part of this form will be stored by a third-party service provider. If you do not wish to provide personal information such as your SSN or ID# on the JotForms site, we require that you provide them in person at the Utility Billing office or provide it to us by phone at 801-789-6609. To view details regarding the security measures put in place by JotForms, please visit: https://www.jotform.com/security/
OFFICE USE ONLY
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Please Note:
Eagle Mountain City will abate utility service fees for those with an active account in the deployed resident's name from the application date above (if after the commencement of the active duty deployment period) or from the commencement of active duty deployment status, until two (2) months following the ending date of the active duty deployed commitment period. This is subject to the receipt of a copy of the military personnel's official active duty deployment orders by the Utility Billing Department.

The amount of the utility service fees abatement will be $25.00 of the total monthly utility bill. Eagle Mountain City may discontinue this abatement at any time and for any reason.
Upload a Copy of Military Personnel's Official Active Duty Deployment Orders and Photo ID*

Cancelof

I blanks* , certify that myself or my spouse has received active duty deployment orders by an official branch of the United States military and have provided a copy of the official orders received as verification of active duty deployment status. I further certify that myself and/or my spouse are the responsible parties for the utility service at the address shown on this form and that the copy of official orders submitted has been properly executed and is genuine. I also agree to notify Eagle Mountain City immediately following any change in orders or assignment that could affect this agreement.
Signature*

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Printed Name*
Date
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OFFICE USE ONLY