APPLICATION FOR REFUSE SENIOR CITIZEN DISCOUNT

							        APPLICATION FOR REFUSE SENIOR CITIZEN DISCOUNT



Name:________________________________________

Address_______________________________________

Date of Birth___________________________________

Number of persons at residence____________________



The Village of Shorewood offers a $1.00 discount from the monthly refuse and recycling unit
rate for senior citizen that are 1) 65 years of age and older and 2) live alone or with their spouse.
The discount is only applicable to the dwelling unit in which the Senior Citizen resides and
owns.

To obtain the discount, the residents must present proof of the following to the Village:

       1.      Proof of age, being 65 years or older: (i.e. valid drivers license)

       2.      Ownership of the property: (i.e. tax bill, real estate bill)

       3.      Residency of the property: (i.e. driver license, state issued id card)

I hereby certify that the above information and the items submitted as listed below are true and
valid.




                                       _____________________________            ____________
                                       Senior Citizen/Homeowner                     Date




                                       _______________________________
                                       Village Signature