Peters Township Solid Waste & Recyclables Collection 2009-2010 Discount Application Application Deadline: June 15, 2010 Name Date of Birth Address Phone Number Check here if spouse is deceased Check here if you are on full disability* If yes, see comments below Income Information: Please include all income received by you, your spouse and any other permanent resident of your household in 2009. Please include a copy of proof of income. Social Security, SSI Payments & Railroad Retirement Benefits $ Pension and Annuities $ Interest, Dividends and Capital Gains $ Rental Income $ Net Business Income $ Other Income Including Wages, Public Assistance, Unemployment Benefits, Gifts, Lottery Winnings, Alimony, $ Spousal Support,Inheritance Please Indicate: My garbage is collected at the street curb My garbage is collected at the rear of my house/garage I am currently receiving the 10% senior discount I declare that the information provided on this application is to the best of my knowledge true, correct and complete and authorize Peters Township to verify my income through Peters Township Wage Tax Office and the Commonwealth of Pennsylvania. Print/Sign Name Submit by Email Print Form *For proof of disability you must submit a copy of award letter from Social Security or other appropriate agency or from the Veterans Administration stating you are 100% disabled.
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